List of Commercial Ins Denial Codes (2024) – BCBS

Blue Cross Blue Shield denial codes or Commercial ins denials codes list is prepared for the help of executives who are working in denials and AR follow-up. Most of the time when people work on denials they face difficulties to find out the exact reason of denials, so this Blue Cross Blue Shield denial codes or Commercial insurance denials codes list will help you.

Blue Cross Blue Shield Denial Codes List

Denial Codes	Description	CARC	RARC
2	Charge exceeds the maximum allowable under  member’s coverage.	45
8	Service is limited by the member’s plan. Benefits were extended by our Utilization Management department.	119
18	Charge exceeds the maximum allowable under  member’s coverage	45
01D	Processing of  Claim was suspended awaiting information requested from  provider or subscriber.	133
02D	Benefits for  service are limited to two times per contract year.	273	N435
03D	Benefits for  service are limited to one time per three-month period.	273	N435
04D	Benefits for  service are limited to one time per thirty-six month period.	273	N435
50	Charge exceeds the maximum allowable under  member’s coverage.	59	N644
54	Services denied due to being delegated to another entity.	109	N418
57	We are deducting  amount because of an overpayment on a previous FSA Claim.
05D	Benefits for  service have a twelve-month waiting period.	179
62	These expenses are not eligible since there is no money left in your Flexible Spending Account.	187
66	Service is not a covered  under medical benefits. The service is eligible under the Health Reimbursement Account.	96	N30
68	These expenses are not eligible since there is no money in your Flexible Spending Account.	187
69	These expenses are not eligible since there is no money in your Flexible Spending Account.	187
06D	Service was performed on a previously missing tooth.	272
71	Your Dependent Care Flexible Spending Account funds have been exhausted. Payment may be made when additional funds are available.	187
73	Benefits for  service are excluded under  member’s plan.	96	N216
77	Long Term Care Hospital Override
79	Line Item Denial Override
07D	Benefits for  service are limited to two times per twelve-month period.	273	N412
08D	Services for hospital charges, hospital visits, and drugs are not covered.	96	N216
09D	Services for premedication and relative analgesia are not covered.	96	N126
0DA	This is an adjustment to a previous dental Claim that paid to the provider but should have paid to the subscriber.	96	MA67
0s0	Change Secondary Coinsurance Amount
0s1	Change Secondary Copay Amount
104	Member’s coverage excludes benefits for the condition for which  service was rendered.	96	N216
10D	Benefits for sealants and dietary instruction are not covered.	96	N216
11D	The Procedure code and tooth number filed do not correspond. An alternate Procedure code was used for pricing.	169
12D	Benefits for  Procedure are limited to once per lifetime, per tooth and tooth surface.	119	N587
13D	Appliances due to wear and services to improve bite or to correct congenital or developmental problems are non-covered.	96	N216
14D	Benefits for implants, TMJ (Temporomandibular Joint) Dysfunction and periodontal splinting are not covered.	96	N216
15D	Benefits for  service are limited to one time per three-month period.	273	N435
16D	We cannot process  Claim until we receive previously requested information concerning the member’s other insurance.	22
17D	Benefits for services that are considered to be primarily cosmetic are not covered.	96	N383
17d	A portion of these services is considered primarily cosmetic and will not be covered.	96	N383
18D	Procedure is not covered, an allowance for a standard Procedure was paid.	169
19D	Benefits for  service are limited to two times per calendar year.	273	N435
1DA	Dental Claim is being adjusted due to a corrected billing submitted by the provider.	96	MA67
1DO	Temporary Procedure has been deducted from the amount of the primary Procedure.	169
1s1	Secondary Supplementation Amount
201	Interest is being recouped.	85
20D	Relines cannot be billed separately if done within six months of the primary denture and or partial Procedure.	273	N435
217	Paid Limit Accumulator Has Been Altered by Med Supp Sequestration Reduced from the Paid Amount
21D	Benefits for  service are limited to one time per sixty-month period.	273	N435
22D	Benefits for  service have a twenty-four month waiting period.	179
23D	These benefits have been paid by the member’s medical policy.	168
24D	Benefits for  service are limited to one time per six-month period.	273	N435
25D	Category of dental benefits has a waiting period as specified in  member’s dental contract.	179
26D	Benefits for  service are limited to one time per five-month period.	273	N435
27D	Benefits for  dental service are not available, per  member’s contract.	96	N216
28D	Benefits for  service are limited to one time per twelve-month period.	273	N435
29D	Benefits for  dental service are not available, per  member’s contract.	96	N216
2s2	Secondary Allow Amount
30D	Charge is a duplicate of a previously processed Claim for  member.	18	N702
30d	Procedure is a duplicate of a previously filed Procedure.	18	N522
31D	Service is denied based on information submitted. Participating dentist should charge only amount in ‘Patient Owes’.	96	N10
328	Claim was adjusted to provide corrected benefits.	96	MA67
32D	Benefits for  service are limited to one time per four-month period.	273	N435
33D	Benefits for  service are limited to one time per two-year period.	273	N435
341	Claim was paid to the wrong payee.	96	MA67
342	Claim was paid to the wrong payee.	96	MA67
343	Claim was paid to the wrong payee.	96	MA67
344	Member’s coverage under  plan was not in effect on the date  service was provided.	27	N30
345	Benefits for  service are excluded under  member’s plan.	96	N30
346	Duplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.	18	N702
347	Benefits for  service are excluded under  member’s plan.	96	N30
348	Benefits are excluded for an on the job injury or for services eligible for Worker’s Compensation benefits.	19	N418
349	Claim was adjusted to provide benefits secondary to Medicare.	96	MA67
34D	Benefits for  service have a ninety-day waiting period.	179
350	It is a subrogation adjustment. It will not effect previously assigned patient liability.	215
351	Claim was adjusted to provide benefits secondary to  member’s other insurance coverage.	96	MA67
352	Claim was previously processed under another member’s name or ID number in error.	96	MA67
353	Claim was previously processed under another member’s name or ID number in error.	96	MA67
354	Claim was adjusted to provide corrected benefits.	96	MA67
355	Claim was adjusted to provide corrected benefits.	96	MA67
356	Claim was adjusted to provide corrected benefits.	96	MA67
35D	Benefits for  service are limited to one time per twenty-four month period.	273	N435
365	Claim was adjusted to provide corrected benefits.	96	MA67
366	Claim was adjusted to provide corrected benefits.	96	MA67
367	Claim was adjusted due to a change in provider information.	96	MA67
368	Claim was adjusted due to a change in provider information.	96	MA67
369	Claim was adjusted to provide benefits secondary to Medicare.	96	MA67
36D	These benefits were previously paid under an incorrect provider status.	170	N95
370	Claim was adjusted to provide corrected benefits.	96	MA67
371	Claim was adjusted to provide corrected benefits.	96	MA67
379	It is a subrogation adjustment. It will not effect previously assigned patient liability.	215
37D	Service needs to be resubmitted using current American Dental Association Procedure codes.	181	M20
37d	Service needs to be resubmitted using current American Dental Association Procedure codes.	181	M20
380	Claim was adjusted to provide benefits secondary to Medicare.	96	MA67
381	Please submit a copy of the Explanation of Benefits from  member’s other insurance carrier.	22	MA92
382	Claim was adjusted to provide benefits secondary to Medicare.	96	MA67
383	Claim was adjusted to provide corrected benefits.	96	MA67
384	Claim was adjusted to provide corrected benefits.	96	MA67
385	Claim was adjusted because we were notified that the provider billed for  service in error.	96	MA67
389	Claim was adjusted to provide corrected benefits .	96	MA67
38D	Service has been denied due to contract limitations.	273	N435
390	Claim was adjusted to provide corrected benefits.	96	MA67
391	Service was previously denied as a duplicate in error.	96	MA67
392	Claim was adjusted to provide corrected benefits.	96	MA67
393	Claim was adjusted to provide corrected benefits.	96	MA67
394	Claim was adjusted to provide corrected benefits.	96	MA67
395	Claim was adjusted to provide corrected benefits.	96	MA67
397	ITS Inclusive Grouping Number
39D	Benefits for  service are limited to one time per year.	273	N435
3s3	Supplemental Calculation Method
40D	Date of service is after  member’s termination date.	27	N30
41D	Service has been paid based on group’s request.
42d	McKee Executive Dental payment reimbursement
43D	Processing of  Claim is suspended awaiting information from the provider.	163	N686
44D	Charge exceeds the maximum allowable under  member’s contract.	45
46D	Processing of  Procedure is suspended awaiting information from  member’s medical or other carrier’s policy.	168
47D	Benefits for adult orthodontics are only payable for TMJ Diagnosis.	96	N569
48D	Benefits for  service are limited to one time per forty-eight month period.	273	N435
4s4	Change Secondary Service Rule
500	Submitting IPA is not related to member’s IPA
501	Capitated entity charge amount equal 0.00
502	Prudent Layperson Override
503	Delegated Claim Entity Override
504	Capitation Indicator
505	Capitation Fund
506	Risk Indicator
507	Delegated UM Entity Override
508	Capitation Deduct
509	Opt out override
50D	Benefits for  service are limited to three times per twelve-month period.	273	N435
510	Service Area Override
511	Reimbursable allowable amount
51D	Grace period for plan limits.	45
54D	Benefits for  service are limited to one time per calendar year.	273	N435
55D	Benefits for  service are limited to once per lifetime.	273	N435
56D	Benefits for  service are limited to four times per calendar year.	273	N435
57D	Benefits for  service are limited to one time per three-year period.	96	N130
57d	Benefits for  service are limited to one time per three calendar year period.	273	N435
58D	Please submit a copy of the Explanation of Benefits from  member’s other insurance carrier.	22	N4
59D	Benefits for  service are limited to one time per five-year period.	273	N435
5s5	Bypass Secondary Plan Limits
60D	The combination of x-ray charges submitted on  Claim should not exceed the cost of a full mouth series.	169
61D	Allowance is based on a less costly Procedure. The disallowed amount will be the patient’s responsibility.	169
61d	Procedure is non covered. An alternate standard Procedure has been used to price the allowed.	169
62D	The combination of x-ray charges submitted on  Claim should not exceed the cost of a full mouth series.	169
63D	Benefits for crowns are available only when the tooth cannot be restored by any other material.	96	M25
6s6	Change Secondary Allow per Unit
704	Service needs to be resubmitted using current American Dental Association Procedure codes.
7s7	Change Secondary Allowed Units
82D	Member or dependent is not eligible for dental benefits.
83D	Member is not eligible for dental benefits.	96	N216
84D	Member is not eligible for dental benefits.	96	N216
85D	Patient has met his or her annual or lifetime maximum benefits.	119	N587
89D	Dental Claim was processed in error.
8s8	Change Secondary Disallow Amount
90D	Member’s contract does not allow for crown coverage. An allowance has been made for a stainless steel crown.	169
95D	Temporary partials are only covered for the anterior front teeth.	96	N130
97D	Charge is considered part of the total cost. Please do not bill separately.	169
98D	Dental Claim was processed in error.	B11	N216
9s9	Change Secondary Deductible Amount
A01	Provider is not eligible under  member’s coverage.	170	N348
AB0	Call 1-800-924-7141 for Claim detail if needed.
AD3	It is a subrogation adjustment. It will not affect previously assigned patient liability.	215
AD4	It is the disallowed amount prior to subrogation adjustment.	215	MA67
ADP	Amount was previously paid to the wrong payee. A corrected payment has been made.	96	MA67
ADT	It is an adjustment of a previously processed Claim due to a BCBST change to the provider assignment.	96	MA67
ADX	Claim was adjusted due to a change in provider information.	96	MA67
AUT	Benefits cannot be provided for  service because the required authorization is not on file.	197
AY1	Outside Year Period Override
AZP	Medication is to be dispensed by CVS Specialty at 1-888-265-7990. A one time exception was allowed under your medical plan.		N189
B01	Procedure is not covered per contract limitations. Alternate Procedure pricing was used.	169
B02	Number of services exceeds contract limitations. An alternate Procedure was used.	169
B03	Benefits for  service are limited to one time per seven year period.	273	N435
B08	Member’s coverage does not provide benefits for TMJ (Temporomandibular Joint) Dysfunction and occlusion.	96	N216
B09	Member’s coverage does not provide benefits for implants and periodontal splinting.	96	N216
B10	Member’s coverage does not provide benefits for basic restorative dentistry.	96	N216
B11	Member’s coverage does not provide benefits for crown and prosthetic dentistry.	96	N216
B12	Member’s coverage does not provide benefits for orthodontic dentistry.	96	N216
B13	Member’s coverage does not provide benefits for gold foil restorations.	96	N216
B14	Member’s coverage does not provide benefits for dental care that is elective or a special technique.	96	N216
B15	Member’s coverage does not provide benefits for replacement services due to loss or theft.	96	N216
B16	Member’s coverage does not provide benefits for desensitizing teeth.	96	N216
B17	service is primarily considered medical. Please file with  member’s medical policy.	168
B18	Member’s coverage does not provide benefits for adult orthodontics.	96	N216
B19	Member’s coverage does not provide benefits for prescribed drugs and other medications.	96	N216
B20	Member’s coverage does not provide benefits for congenital, cosmetic or aesthetic services.	96	N216
B21	Member’s coverage only allows for sealants on the occlusal biting surface of a tooth.	96	N216
B22	Service is primarily considered medical. Please file with  Member’s medical policy.	168
B23	Provider is not eligible under  Member’s coverage.	185
B24	Patient has met his or her annual or lifetime maximum benefits.	119	N587
B25	Benefits for  service have a twelve-month waiting period.	273	N435
B26	Benefits for  service have a twenty-four month waiting period.	273	N435
B27	Benefits for  service have a ninety-day waiting period.	179
B28	Service is not covered when performed on the same day as a related Procedure.	273	N435
B29	Benefits cannot be provided for a prosthetic device that replaces one or more teeth that were missing prior to the policy effective date.	96	N130
B30	Service is not covered unless specific Services are performed in conjunction with or prior to  Service.	96	N130
B31	Charge exceeds the maximum allowable under  Member’s coverage.	45
B32	Service is not covered when performed within 90 days of another active surgical or non-surgical Procedure.	273	N435
B33	Benefits cannot be provided until we receive information about  Member’s eligibility.	252	N375
B34	Benefits for  Service are limited to one time per ten year period.
B35	Benefits payable for  Member’s orthodontic treatment has been provided.	96	N130
B36	Patient has met his or her dental quarterly maximum benefits.	119	N640
B37	Benefits for  Service are limited to four times per twelve-month period.	273	N435
B51	Service does not meet BlueCross BlueShield of Tennessee clinical criteria and will not be considered for payment.	96	N130
B52	Recementing or repairs cannot be billed separately if done within twelve months of the initial placement Procedure.	273	N435
B53	A deleted Procedure code was filed.  code was replaced with a current Procedure code.	181	M20
B54	Recementing or repairs cannot be billed separately if done within six months of the initial placement Procedure.	273	N435
B59	Service is considered part of the primary Procedure. Please do not bill separately.	97	N19
B61	The servicing provider has billed  Claim under the incorrect patient.	96	N10
B62	Claim must be filed by the provider who actually rendered the Service.	96	N32
B63	Claim was adjusted because it was previously processed under a different patient.	B13
B64	Charge was adjusted because we were notified that the provider billed for  Service in error.	96	N10
B65	Claim was paid to the wrong payee.	96	N10
CBM	Member’s primary insurance carrier already paid  amount.	23
CCC	The payment for  Service is to reimburse the provider for patient care coordination.	24	M112
CDD	Claim is a duplicate of a previously submitted Claim for  member.	18	N522
CG0	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CG1	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CG2	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CG3	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CG4	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CG5	Service falls into a category that is not covered under  Member’s dental plan.	96	N216
CM1	charge exceeds the previous carrier’s allowed amount. Provider has agreed not to bill the patient for  amount.	45
CM2	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
CMS	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
CO1	payment was secondary to primary benefits provided by  Member’s other health insurance.	23
CO2	amount includes the benefits provided by  Member’s other insurance carrier.	23
COB	Benefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.	252	N686
COS	Procedure is not eligible for benefits under  Member’s coverage because it was performed for cosmetic purposes.	96	N383
CPY	The original Copay amount has been reduced to a percentage of the allowable amount
CR	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
CRT	CREdit-ADJUSTMENT-OVERPAYMENT TO BE DEDUCTED FROM PAID AMOUNT. Message appears on RA when auto deduct of overpayment.
CVX	Coverage Exclusion	96	N30
D01	The dental allowable amount was increased.	45
D02	The dental allowable amount was decreased.	45
D11	The dental allowable amount per unit was increased.	45
D12	The dental allowable amount per unit was decreased.	45
D13	The dental allowable units were increased.	45
D14	The dental allowable units were decreased.	45
D15	It is  dental disallowed amount.	96	N130
D21	Please submit the date orthodontic treatment started.
D22	Please submit accompanying x-rays for  dental Procedure.	16	M129
DA0	dental Claim is being adjusted since we have been notified that the provider billed for  Service in error.	96	MA67
DA1	Claim was previously paid to the wrong provider. A payment has been made to the correct provider.	96	MA67
DA2	Claim was previously processed correctly under another ID number or patient’s name. No additional payment is due.	96	MA67
DA3	Disallowed amount is the ortho extended treatment and has been moved to another Claim.	172
DA4	it is an adjustment to a previous dental Claim that paid to the subscriber but should have paid to the provider.	96	MA67
DA6	A dental adjustment is in process for  Claim, which will be reprocessed on a future date.	96	MA67
DA7	It is an adjustment to a previously paid dental Claim. The payable amount is less than the amount originally paid.	96	MA67
DA8	It is money reimbursed due to another party’s payment. Refer to Patient Owes column for any liability charges.	215
DA9	Dental Claim was previously processed with an incorrect date of Service.	96	MA67
DAC	Other insurance information has been received and  Member’s records updated.  Claim has been adjusted.	96	MA67
DAD	Full or partial dental benefits were denied in error.	96	MA67
DAL	It is a dental adjustment. The provider was corrected and or subscriber payment liability.	96	MA67
DAP	The originally submitted Procedure was replaced due to benefit plan restrictions.	169
DB0	Dental Claim has been adjusted due to an incorrect tooth and or surface.	96	MA67
DB1	Dental Claim was adjusted due to an incorrect Procedure code.	96	MA67
DB2	Claim was denied for an Explanation of Benefits.
DB3	Claim paid secondary to another insurance carrier.
DB4	Dental Claim was denied requesting additional information from the provider.
DB5	A dental adjustment has been completed and has resulted in a statistical change.	96	MA67
DB6	Claim was adjusted because the Member’s eligibility has been updated.	96	MA67
DCG	Override Dental Category
DEN	Dental Service is not eligible for benefits under  Member’s coverage.	96	N216
DG2	The allowable is a discounted DRG amount.	45
DGE	Override Age Limitation
Dis	Charge exceeds the maximum allowable under  Member’s coverage.	45
DMD	Oral surgery Service does not meet the requirements of  Member’s program for coverage.	96	N216
DOP	We are deducting  amount because of an overpayment on a previous Claim.	172
DP0	Patient’s age is not within the normal range established for  dental Procedure.	96	N130
DP1	Pental Procedure is not a covered Service for  tooth/teeth numbers.	96	N130
DP2	The charge or number of occurrences  Procedure was performed has exceeded the contract limits.	273	N435
DP3	The charge or number of occurrences  Procedure was performed has exceeded the contract limits.	273	N435
DP4	The charge or number of occurrences  Procedure was performed has exceeded the contract limits.	273	N435
DP5	The number of occurrences  Procedure was performed has exceeded the contract limits.	273	N435
DPX	Your group’s contract requires a period of membership before benefits are available for  Service.	51	N607
DRC	The dental runout time limit has been exceeded.	29
DRE	Claim is prior to effective date of the coverage.	26	N30
DRQ	Date of Service (DOS) is after the termination of coverage.	27	N30
DRT	Timely filing has been exceeded.	29
DSR	Your Claim has been received and is currently under special review.	216
DUP	Duplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.	18	N522
DWP	Override Dental Category Waiting Period
ECT	ECT single or multiple is not a billable Service for  discipline level.	185	N684
EMR	Amount was previously reimbursed and is not included in the Executive Medical Reimbursement.	96	M86
EMr	Amount is for Executive Medical Reimbursement.	96	M86
EOB	Please submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.	22	MA04
EXC	Claim was paid as an exception. Future Claims without a referral from the Member’s PCP will be denied.	45	N189
FTP	Family therapy is a non-covered Service.	96	N30
FYI	RECALCULATED PAYMENT – EXCLUDED FROM AMOUNT PAID. (Message appears on RA when auto deduct of overpayment.)
G44	Check amount is the outstanding balance (minus deductible and coinsurance) that the provider may bill.	96	N30
GAR	Execution Of Garnishment
GLB	Claim is disallowed because it is included in the global case payment.	97	N525
GNS	The provider must file  Claim with Magellan, P.O. BOX 5190, Columbia, MD 21046.	109	N418
GRP	The Member’s group has already paid for  Claim. We are reimbursing the Member’s group by manual check.	96	N30
HLD	There is a hold on payment of  Claim.	96	N30
HM0	Call 1-800-924-7141 for Claim detail if needed.
HRA	amount was paid from the Member’s Health Reimbursement Account.	187
INF	Medical records have been requested from the provider.	252	M127
INH	Charge exceeds the maximum allowable under  Member’s coverage.	45
INV	Procedure is considered investigative and is not covered under  Member’s plan.	55	N623
IPM	Individual Psychotherapy with Medical Management is non-covered.	96	N30
IRS	Execution of IRS Levy
is1	It is the State surcharge amount which is payable to the provider.	96	N30
isS	Service is not covered per the information submitted. The provider should verify coding and resubmit if incorrect.	16	MA39
ITA	Benefits cannot be provided for  Service because the required authorization is not on file.	197
ITD	The provider must file  Claim with his or her local BlueCross BlueShield plan for processing.	109	N418
LAB	Lab charge was already paid to the lab that performed the Service. The patient should not be billed.	24
LB1	Lab charge was already paid to  Member’s physician. The patient should not be billed.	24
LET	Benefits cannot be provided for  Service. We are sending the member additional correspondence to explain.	96	N179
LOV	Charge exceeds the maximum allowed under  Member’s coverage.	45
M09	The provider has not contracted to provide  Service.	96	N448
MAD	Portion of your Medicare Part A deductible is not covered under your supplemental policy.	96	N30
MAR	Call 1-800-924-7141 for Claim detail if needed.
MAT	A portion of  Claim is denied because  member was not eligible for benefits for the entire term of the pregnancy.	179
MBD	Member’s plan does not cover the Medicare Part B deductible.	96	N30
MCC	We cannot pay benefits until  Member’s out-of-pocket amount has been satisfied.	96	N30
MCD	Charge was denied by Medicare and is not covered on  plan. The provider can bill the patient.	96	N30
MDC	Amount exceeds the reimbursement due to Medicaid.	45
MED	Please submit a copy of the Medicare Explanation of Benefits (EOB) so we can determine benefits.	22	MA04
MLN	The provider must submit the primary Diagnosis.	11	N657
MPF	Medicare paid  Service in full.	23
MPf	Medicare paid  Service in full.	23
MR1	Medicare denied  charge and the provider cannot bill you for it.	45
MR3	The provider agreed to accept the amount allowed under  Member’s contract for  Service.	131
MSD	The allowable amount for  Service has been reduced according to multiple same day surgery guidelines.	59	N644
MSP	Payment is secondary to benefits provided by Medicare.	23
MTN	Service was prepaid by Middle Tennessee IPA.	24
MXC	The provider’s charge exceeds the amount allowed by Medicare. The member is not responsible for  amount.	45
Mds	It is a non-participating facility. The Medicare Part A deductible/coinsurance is not covered under  Member’s plan.	242	M115
Mrx	These benefits are reduced because a non-participating pharmacy was used.	242
N01	Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.	97	M80
N02	The Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.	97	M80
N03	Procedure is secondary to the primary Procedure and is limited by  Member’s plan.	97	M80
N04	Service is a part of the original surgical Procedure and is limited by  Member’s plan.	97	M144
N05	Service is not covered when performed on the same day as a surgical Procedure.	97	N20
N06	Procedure does not normally require the Services of an assistant surgeon.	54	N646
N09	Procedure is not eligible for benefits under  Member’s coverage because it was performed for cosmetic purposes.	96	N383
N10	Procedure is considered investigative and is not a covered Service under  Member’s plan.	55	N623
N11	Procedure is no longer considered clinically effective and is not eligible for benefits.	56	N623
N13	It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.	182	N657
N14	Service is not covered for  member. The provider should submit the proper code or medical documentation.	16	MA39
N15	Service is not normally performed for members in  age range.	6	N129
N16	Service is not normally performed for members in  age range.	6	N129
N17	Service is not covered when performed in  setting.	96	N428
N19	Service is not covered when performed for the reported Diagnosis.	11	N657
N25	The charge for  Service has been combined with the primary Procedure.	234	M15
N26	Service is a part of the original surgical Procedure and is limited by  Member’s plan.	97	M144
N29	Procedure is redundant to the primary Procedure and is limited by  Member’s plan.	97	M80
N30	The maximum amount allowable for  equipment has been reached.	45
NB	These benefits are for an eligible newborn who has not been added to subscriber’s plan.	96	N30
NCC	Member’s coverage excludes benefits for the condition for which  service was rendered.	96	N216
NCP	Benefits for  Service are excluded under  Member’s plan.	96	N216
NEC	Benefits cannot be provided for Services that have been determined not to be medically necessary.	50	N130
NER	Benefits cannot be provided for Services not considered a medical emergency.	40
NRT	It is a non-contracted room type. The room type is disallowed.	45
O25	The charge for  Service has been combined with the primary Procedure.	169
OAS	Service is not normally covered for members in  age range.	6	N129
OJI	These Services are related to an on-the-job injury.	19
OOA	Claim was filed by an out of area dental provider.
OPC	Override PCA Disallow
OTC	Drugs that can be purchased without a prescription are not an eligible expense.	96	N30
OTc	Drugs that can be purchased without a prescription are not an eligible expense.	96	N30
OUT	These benefits have been reduced because a non-participating provider was used.	242	N130
OVP	We are deducting  amount because of an overpayment on a previous Claim.	96	N10
P50	Present On Admission indicator required but is not valid.
P59	There are one or more Edits present that cause the whole Claim to be rejected.	96	N56
P60	There are one or more Edits present that cause the whole Claim to be returned to the provider.	96	N56
P61	There are one or more Edits present that cause the whole Claim to be rejected.	96	N56
P62	There are one or more Edits present that cause the whole Claim to be denied.	96	N56
PAA	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAC	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAH	APC Rate
PAI	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAK	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAL	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAP	Charge exceeds the maximum allowable under  Member’s coverage.	45
PAR	Charge exceeds the maximum allowable under  Member’s coverage.	45
PCD	Charge exceeds the maximum allowable under  Member’s coverage.	45
PCP	member has not chosen a PCP or has selected a PCP who is not participating in the plan.	242	N130
PCS	prescription requires prior authorization through your pharmacy.	197
PDA	Charge has been reduced based on a discount arrangement with  provider.	45
PDC	Charge has been reduced based on a discount arrangement with  provider.	45
PDD	Charge has been reduced based on a discount arrangement with the provider of Service.	45
PDP	Charge has been reduced based on a discount arrangement with  provider.	45
PE0	Charge exceeds the maximum allowable for  Service.	45
PED	Routine nursery or pediatric care of a newborn is not eligible for benefits.	96	N30
PEN	Benefits for  Service have been reduced due to lack of compliance with plan requirements.	197
PEO	Charge exceeds the maximum allowable under  Member’s coverage.	45
PEX	Charge exceeds the maximum allowable under  Member’s coverage.	45
PFC	Charge exceeds the maximum allowable under  Member’s coverage.	45
PFS	Charge exceeds the maximum allowable under  Member’s coverage.	45
PFU	Charge exceeds the maximum allowable under  Member’s coverage.	45
PFV	Charge exceeds the maximum allowable under  Member’s coverage.	45
PFW	Charge exceeds the maximum allowable under  Member’s coverage.	45
PGA	Charge is not reimbursed according to your DRG contract. Please see the provider manual.	45
PGD	Charge exceeds the maximum allowable under  Member’s coverage.	45
PGE	Charge exceeds the DRG rate for  confinement.	45
PGO	Charge exceeds the maximum allowable under  Member’s coverage.	45
PGP	Charge exceeds the maximum allowable under  Member’s coverage.	45
PGR	Charge exceeds the maximum allowable under  Member’s coverage.	45
PHA	Pharmacological Management is non-covered.	96	N30
PHH	Hold Harmless Payment Applied
PHY	Physician fees should be filed separately from the hospital Claim. The provider should rebill on the proper form.	89	N200
PI	Personal items cannot be considered for benefits.	96	N30
PLC	The Medicare limiting Charge was applied.	96	N30
PLP	Percent Threshold Stoploss Met	119
PPD	Service is included in the ordering physician’s agreement. It should be billed to the ordering physician.	24
PRO	Professional Pricer Reduction
PS	Charge exceeds the maximum allowable under  Member’s coverage.	45
PS0	Benefits for  Service are excluded under  Member’s plan.	96	N30
PS1	The maximum amount payable under  Member’s coverage for  Service has been provided.	119	N587
PS2	The maximum number of Services payable under  Member’s coverage has been provided.	119	N362
PS3	Drugs that can be purchased without a prescription or other non-covered drugs are excluded under  Member’s plan.	96	N30
PS4	Maximum benefits payable under  Member’s coverage have been provided.	119	N587
PSB	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSC	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSM	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSN	Charge Exceeds SNF amount for Services
PSR	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSS	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSU	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSV	Charge exceeds the maximum allowable under  Member’s coverage.	45
PSW	Charge exceeds the maximum allowable under  Member’s coverage.	45
PT1	Bypass Provider Termination Date Override
PTR	The maximum number of units allowed for  Service under  Member’s coverage has been provided.	119	N362
PU4	Milliliters
PU5	Units
PX	Charges for a pre-existing condition are not eligible for benefits.	51
PXN	NetworX Std Fee Schedule	45
RB	These Charges exceed the maximum room and board allowance under  Member’s coverage.	78
RDP	Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.	97	M80
REC	MONEY RECEIVED – NO DEDUCTION FROM AMOUNT PAID. (Message appears on RA when auto recovery bypassed).
REF	These Services were provided after the time limit specified in the referral from the PCP or  Member’s plan.	95	N630
REJ	Service is not covered under  Member’s plan.	96	N30
REX	Routine examinations are not eligible for benefits under  Member’s plan.	49	N429
RFD	The referral for these Services was denied and benefits cannot be provided under  Member’s plan.	16	N335
RFN	Benefits cannot be provided for these Services because we have no record of a referral from  Member’s PCP.	16	N335
ROU	Routine Services are not covered under  Member’s plan.	49	N429
RPC	Charges cannot be considered if the referring provider’s National Provider Identifier is not present on the Claim.	16	N286
RWC	Recoup due to Subrogation/Workers Comp Third Party Liability overpayment.
RWD	A risk withhold has been applied to  Service. The member is not responsible for  amount.	104
RXD	Amount was applied to your prescription deductible.	1
RXI	Save $$ on drug cost. Show your BlueCross BlueShield ID card and use a member pharmacy when buying prescription drugs.	96	N30
RY1	We have paid the annual maximum allowable for these Services for  member.	119	N362
RY2	The maximum days allowed for these Services have been used for  member.	119	N362
S10	Member’s coverage ended before the date these Services were provided.	27	N30
S11	Member’s coverage was not in effect on the date  Service was provided.	26	N30
S12	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S13	Member’s coverage was not in effect on the date  Service was provided.	26	N30
S14	Member’s coverage did not take effect until after the date  Service was provided.	26	N30
S16	Member’s coverage was not in effect on the date  Service was provided.	26	N30
S17	Member’s coverage was not in effect on the date  Service was provided.	27	N619
S1A	Member’s coverage was not in effect on the date  Service was provided.	26	N30
S1B	Member’s coverage was not in effect on the date  Service was provided.	26	N30
S1C	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S1D	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S1E	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S1F	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S2	Member’s coverage was not in effect on the date  Service was provided.	14
S20	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S21	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S22	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S23	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S24	Member’s coverage was not in effect on the date these Services were provided.	26	N30
S25	We have placed a hold on all Claims administration for  subscriber and related members.	26	N30
S3	Member’s coverage was not in effect on the date  Service was provided.	14
S4	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S5	Member’s eligibility does not include coverage for  type of Service.	31
S6	Member’s age is beyond the limiting age for the plan.	32	N129
S61	member is older than the plan’s age limit for coverage of  Service.	32	N129
S7	Member’s age is beyond the limiting age for the plan.	27	N30
S8	Member’s age is beyond the limiting age for the plan.	27	N30
S9	Member’s coverage was not in effect on the date  Service was provided.	27	N30
S?	member was not eligible for coverage on the date  Service was provided.	27	N30
SB	Patient is not a covered member under the plan.	33
SC	Patient is not a covered member under the plan.	33
SD	Patient is not a covered member under the plan.	33
SDP	Service is not covered when performed on the same day as a surgical Procedure.	97	N20
SE	Patient is not a covered member under the plan.	33
SF	Patient is not a covered member under the plan.	33
SG	Patient is not a covered member under the plan.	33
SH1	Charge is a duplicate of a previously processed Claim.	18	N522
SHD	Charge is a duplicate of a previously submitted Charge for  member.	18	N522
SL	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SL2	Charge was discounted under the provider agreement. You have saved  amount by using a participating provider.	45
SM	Member’s coverage under  plan was not in effect on the date  Service was provided.	13
SN	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SN1	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SNF	The level of care billed does not match the level authorized. The provider must submit a corrected billing.	197
SO	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SO1	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SP	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N619
SPD	Supplemental Discount	45
SPL	Patients stop-loss limit has been reached. Benefits are payable at 100%.	119
SPT	Member’s coverage has terminated.	27	N30
SQ	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SS	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
ST	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
STN	Claim is pended due to non-payment of premiums. The member should contact his or her State Group Representative.	27	N30
STP	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
STU	Benefits cannot be provided until we receive information about  Member’s eligibility.	252	N375
SW	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
SW2	It is a non-billable Service for the discipline level.	185	N684
TF0	The Claim for these Services was received after the time limit specified in  Member’s benefit plan.	29
TF1	The Claim for these Services was received after the time limit specified in the provider’s agreement.	29
TMF	The Claim for these Services was filed after the time limit for filing specified in  Member’s plan.	29
TPS	Payments have been suspended at the direction of the Bureau of TennCare.	B7
TR0	Benefits cannot be provided because there was no authorization and/or referral for  Service.	197
TR1	It is not a covered Service.	96	N30
TR2	The maximum amount payable under  Member’s coverage for  Service has been provided.	119	N587
TR3	The maximum amount payable under  Member’s coverage for  Service has been provided.	119	N587
TR4	The maximum number of Services payable under  Member’s coverage has been provided.	119	N362
TR5	The maximum number of Services payable under  Member’s coverage has been provided.	119	N362
TR6	The payment is reduced by the amount paid by your primary insurance carrier.	23
Th	Member’s coverage was not in effect on the date these Services were provided.	26	N30
Trx	Your annual prescription drug maximum has been met.	119	N587
UAS	Member was not covered under the plan on the date  Service was provided.	26	N30
UCR	Charge exceeds the maximum allowed under  Member’s coverage.	45
UD	These Charges have been disallowed by Utilization Management.	39
UM0	These Services were disallowed by Utilization Management.	39
UM1	The number of Services provided exceeds the number approved in the Utilization Management authorization.	198	N351
UM2	These Services were limited by a Utilization Management authorization.	198	N351
UM3	Benefits cannot be provided because there was no authorization and/or referral for  Service.	197
VBB	An enhanced medical benefit has been applied to a Service on  Claim.
VEX	Member’s coverage does not provide benefits for routine vision examinations.	96	N30
VGC	Member’s coverage does not provide benefits for glasses or contact lens.	96	N30
Vis	Charge exceeds the maximum allowed for vision Services.	119	N587
VNC	Service is not an eligible vision expense under  Member’s coverage.	96	N30
W01	The maximum amount allowable for  equipment has been reached.	45
W02	Charge is more than Medicare allows for  Service. The member is not responsible for  amount.	45
W03	Benefits cannot be provided until a special review is completed.	133
W04	The provider must submit the NDC, drug name, RX number, strength, day supply and quantity before benefits can be provided.	16	M123
W05	The provider must submit a copy of the manufacturer’s invoice before benefits can be provided.	252	M23
W06	The provider must submit the operative report or office notes before benefits can be provided.	252	M29
W07	The provider must submit a Procedure code before benefits can be provided.	16	M51
W08	The information on  Claim does not match the medical records submitted.	250	M127
W09	The provider has not contracted to provide  Service.	96	N448
W0L	The Ambulatory Code Editor detected one or more errors for  Claim line.	16	M50
W10	Procedure is not eligible for benefits when performed in a hospital setting.	96	N428
W11	A copy of the Anesthesia Flow sheet is needed to process  Claim. The provider should submit  information to us.	252	N439
W12	The provider has not contracted to provide  Service.	45
W13	Service is not paid in addition to or separately from the primary Service.	234	N20
W14	Service should not be billed separately from the room and board.	234	M2
W15	Revenue code is not valid for place of Service billed.	16	M50
W16	It is a non-covered Service.	16	M12
W17	Service requires a detailed revenue code. The provider should refer to billing guidelines locator form 44.	16	M12
W18	Requires Case Management approval prior to rendering Services.	197
W19	The provider must submit a hard copy of  Claim with outpatient medical records.	50	M127
W1L	The Claim line contains revenue code 058x, 059x,0275,0276,0277,or 0278 with Charges greater than zero or it has revenue code 0624.	16	M50
W1T	Benefits cannot be provided until the doctor submits additional information for the Abortion, Sterilization or Hysterectomy review.	252	M127
W21	The provider must submit the appropriate CDT/CPT/HCPCS code for  Service.	189	M81
W22	It is not a valid revenue code for  provider. The provider should refer to billing guidelines.	16	M50
W23	It is an inactive revenue code. The provider should refile with a valid code.	16	M50
W24	Service requires a detailed revenue code. The provider should refer to billing guidelines locator form 42.	16	M50
W25	The revenue code is invalid for the place of Service billed. The provider should verify  code.	16	M50
W26	The provider must refer to the billing guidelines for proper billing.	16	N657
W27	The facility has a separate contract for lithotripsy. When billing, the provider must use revenue code 790.	96	N56
W29	The facility did not contract for lithotripsy, revenue code 790. The provider must bill using revenue code 490 or 360.	96	N56
W2A	The provider must refer to the billing guidelines for proper billing.	96	N56
W2L	Claim contains injectable osteoporosis drugs that are not payable because the Claim does not meet all of the required criteria.	50	N130
W30	It is a bundled Service. The payment is included in the Service to which item/Service is incident.	97	M80
W31	Only the initial visit is eligible.	96	N113
W33	These Charges were included in the reimbursement for the mother’s room and board.	128
W34	It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.	182	N657
W35	These DRG outlier days were denied by Utilization Management.	69
W36	These DRG inlier days were approved by Utilization Management.	69
W37	per diem rate was approved for  DRG facility transfer.	232
W38	The amount was disallowed for  DRG facility transfer.	232
W39	DRG code is no longer valid.	A8	N657
W3L	ESRD Claim was billed with another bill type than 72x.	16	MA30
W40	A valid DRG code could not be assigned for the coding that was submitted. The provider must submit valid codes.	A8	N657
W41	Medical Direction of four or more concurrent Procedures is not eligible for reimbursement.	B15	M80
W42	For dates of Service prior to 1/1/01, please submit the Claim to Magellan.	109	N418
W43	Procedure is considered investigative and is not a covered Service.	55	N623
W44	Benefits cannot be provided for Services that have been determined not to be medically necessary.	96	N30
W45	The Claim for these Services was filed after the time limit for filing specified in  Member’s plan.	29
W46	The organ acquisition cost is included in the kidney transplant case rate.	97	N525
W47	It is a non-covered chiropractic Service.	185	N684
W48	Benefits for maintenance or servicing of durable medical equipment within six months of purchase date are not available.	96	N30
W49	Benefits cannot be provided for  Service because the required authorization is not on file.	197
W4L	ESRD Claims must contain condition codes 59,71,72,73,74,76 or 80. Condition codes 73 and 74 cannot appear on the same Claim.	16	M44
W50	Benefits cannot be provided for Services that have been determined not to be medically necessary.	50	N130
W51	CPT code, modifier, or provider type is invalid. The provider should refer to billing guidelines.	96	N56
W52	The provider must submit  patient’s complete medical history before benefits can be provided for  Service.	252	M127
W53	Facility number is used only for Signature members. The provider must refile under the correct provider number.	16	N77
W54	The provider must submit  patient’s medical records. Please reference  Claim number and member id when you submit the records.	252	M127
W55	Benefits are unavailable until we receive the information we requested in a recent letter to the provider’s office.	252	M143
W56	The provider must submit a letter of medical necessity and plan of treatment for  patient.	50	M135
W57	Information has been requested from another provider to completed a pre-existing review. Not action is required.	252	N204
W58	Interim bills should only be submitted once every thirty days for the same hospital stay.	16	M53
W59	Claim was filed under the BlueCare provider number. Please resubmit using the Commercial provider number.	16	N77
W5L	An ESRD Claim must contain a Diagnosis of End Stage Renal Disease.	16	M64
W60	Benefits cannot be provided until the provider submits a manufacturer name, product name, product number, and quantity.	252	M23
W61	Charge exceeds the maximum allowable under  Member’s coverage.	45
W62	Charge exceeds the maximum allowable under  Member’s coverage.	45
W63	The provider has agreed to waive the Medicare Part A deductible and coinsurance.	45	N364
W64	Measurement/Reporting Codes No Fee –  Charge is incidental to the primary Service.	97	M80
W65	Charge is more than Medicare allows for  Service. The member is not responsible for  amount.	45
W66	Charge exceeds the maximum allowable under  Member’s coverage.	45
W67	Service is not covered since it is supplied by the government.	212	N658
W6L	An ESRD Claim must contain a valid weight and height passed through value codes A8 and A9.	16	N207
W71	Charge exceeds the maximum allowable under  Member’s coverage.	45
W72	The rendering provider is not eligible to perform the Service billed.	185	N570
W73	Claim was adjusted following a provider audit.	96	MA67
W74	Medical information is needed to complete a pre-existing review. Correspondence to the provider will follow.	252	N204
W75	Charge exceeds the maximum allowable under the group practice agreement.	45
W76	Charge is included in the facility or physician fee that contracted for  Service.	234	M80
W77	Claim was processed under continuity of care guidelines.	131
W78	Charges do not meet qualifications for emergent/urgent care.	40
W79	The provider must file  Claim with CMS. The Medicare contractor to process  Claim can be identified through the CMS website.	109	N104
W7L	Automated Multi-Channel Chemistry HCPCS component codes must be billed separately.	16	M126
W80	Member’s benefits are based on Medicare’s allowed amount.	23
W8L	ESRD Claim has an invalid modifier for pricing or is missing the required combination of modifier codes	4	N519
W9L	The incorrect number of units billed for revenue code 0634 or 0635 or a dialysis code was billed with units greater than 1.	16	M53
WA0	Charge was adjusted because we were notified that the provider billed for  Service in error.	96	N10
WA1	We cannot provide benefits for Services that have been determined not to be a standard medical Procedure.	56	N623
WA2	Claim must be filed by the provider who actually rendered the Service.	96	N32
WA3	Procedure is not covered when rendered in  place of Service.	96	N428
WA4	Charge exceeds the maximum allowable under  Member’s coverage.	45
WA5	Benefits for  Charge must be determined by filing through  Member’s appropriate pharmacy network.	109	N418
WA7	For dates of Service prior to 1/1/01, please submit the Claim to Magellan.	109	N418
WA8	The provider who rendered these Services is not eligible to assist during surgery.	185	N684
WB0	A completed consent form is required from the provider before  Service can be considered for benefits.	252	N28
WB1	Benefits cannot be provided until a Behavioral Health provider number and/or taxonomy code is submitted with a corrected Claim.	96	N30
WB2	The provider must file  Claim with Tennessee Bureau of Medicaid PO Box 460, Nashville, TN 67202-0460. 1-800-852-2683	109	N418
WB3	The provider must file  Claim with Magellan Health Services, PO Box 85042 Richmond, VA 23261. 1-866-434-5524	109	N418
WB4	Claim is paid according to the State Medicaid Rates due to the Deficit Reduction Act.	45
WB5	Benefits are provided under the Vaccines for Children Program for the handling/administration of the vaccine only.	45
WB6	Benefits can not be provided for out of network Services because the required authorization is not on file.	243	M115
WB7	A completed consent form is required from the provider before  Service can be considered for benefits.	252	N28
WB8	The number of administration Services for these injections must equal injections billed. The provider may need to file a corrected bill.	45
WB9	The provider must submit a valid National Drug Code, unites and quantity qualifier before benefits can be provided.	16	M119
WC	Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.	19	N418
WC1	Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.	19	N418
WCS	Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.	19	N418
WD1	Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.	96	N56
WD2	We are adjusting  Claim because the Procedure was billed in error.	96	MA67
WD3	The provider must refer to billing guidelines for BlueCare or TennCare Select.	96	N56
WD4	is not a valid revenue code for  type of provider. The provider should refer to billing guidelines.	170	N95
WD5	The provider must file  Claim with OPTUM HEALTH ServiceS 1-855-437-3486 (1-855-Here4TN)	109	N418
WD6	The provider must file  Claim with Beacon Health Options 1-888-474-0929	109	N418
WE0	Service is not a covered benefit under the Member’s plan.	96	N30
WE1	Claim was paid to the wrong payee.	96	N10
WE2	The provider must submit Room and Board Charges correctly before benefits can be provided.	16	MA30
WE3	The servicing provider has billed  Claim under the incorrect patient.	16	MA36
WE4	Charge was adjusted because we were notified that the provider billed for  Service in error.	96	N10
WE5	Claim must be filed by the provider who actually rendered the Service.	96	N32
WE6	Claim was paid to the wrong payee.	129	MA130
WE7	Charge has been forwarded to the Member’s appropriate pharmacy network to determine benefits.	109	N216
WE8	Benefits have been provided at the PCP Enhancement Rate.	45
WE9	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	45
WEL	Member’s coverage does not provide benefits for physical examinations and related Services.	49	N429
WF0	Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.	96	N56
WF1	Procedure or related Procedure code cannot be billed on the same or different Claim within ten months.	119	N435
WF2	The provider must submit a valid National Provider Identifier before benefits can be provided.	208
WF4	Payment of Claim is pending receipt of State of Medicaid number or Need Medicaid number and/or Disclosure Form.	16	MA112
WG0	The Claim for these Services was received after the time limit specified in the provider’s agreement	29
WG1	These Services were disallowed by Utilization Management.	39	MA67
WG2	Medical Records are required before outlier days will be reviewed for medical appropriateness.	252	M127
WG3	No approved authorization. Specialty Pharmacy Drug authorizations are handled through PBM Vendor. Please contact CVS/Caremark.	243
WG4	No approved authorization. Specialty Pharmacy Drug authorizations are handled through PBM Vendor. Please contact CVS/Caremark.	243
WGB	These Services should be filed and paid by the behavioral health carrier at ComPsych Claims, PO Box 8379, Chicago, IL 60680-8379.	109	N418
WH0	Claim was adjusted because it was previously processed under a different patient.	B13
WH1	Exceeds maximum units considered medically appropriate.	119	N435
WH2	Service was included in the Bundled Episode Payment.	97	N525
WH3	The maximum amount payable under  Member’s coverage for  bundled episode.	45
WH4	Benefits cannot be provided until the provider submits a brand name, manufacturer name, model and description.	252	M23
WH5	The information on  Claim does not match the medical records submitted	B12
WH6	The provider must submit an itemized or detailed billing before benefits can be provided for  Service.	16	N260
WH7	The provider must submit the NDC, drug name, Rx number, strength, day supply and quantity before benefits can be provided.	16	M123
WH8	Care Coordination fees are not payable.	96	N30
WH9	Care Coordination fees are not payable.	96	N30
WK0	Lab Service is required to be performed by Quest Diagnostics or Solstas Lab Partners.	185
WK1	The provider must file  Claim with his or her local BlueCross BlueShield plan for processing.	109	N418
WK2	Corrected Bill was received after the time limit for submission.	29
WK3	Corrected Bill was received after the time limit for submission.	29
WK4	The provider must submit a correct Procedure code before benefits can be provided.	16	M51
WK5	Statement begin and end dates can’t span calendar months TOB 89X and 66X.	273	N435
WK6	The provider must submit a correct occurrence code before benefits can be provided.	16	M46
WK7	The provider must submit a correct value code before benefits can be provided.	16	M49
WK8	The provider must submit a correct condition code before benefits can provided.	16	M44
WK9	Revenue codes not keyed in date of Service order.	16	M50
WL0	Home Health Claim has a UB04 bill type other than 0322, 0327, 0329, 0332, 0337, 0339, or 034x.	16	MA30
WL1	Home Health Claim has an invalid Service date, from -thru dates or admission date.	16	MA31
WL2	The length of stay for  Home Health Claim is greater than 60 days	16	MA31
WL3	The Home Health Claim has more than one Claim line with a HIPPS code and revenue code 0023.	16	N471
WL4	The Home Health Claim indicates non-routine supplies were provided during the episode, without revenue code 027x or 0623.	16	M20
WL5	Home Health Claim is missing the Core Based Statistical Area in the UB-04 Value Amount with UB-04 Value Code 61.	16	M49
WL6	Claim must have at least on Home Health visit related revenue code	16	M50
WL7	A weight/rate record cannot be found for  particular facility ID, payer ID, effective date and Home Health Resource Group.	16	N471
WL8	Therapy Services billed with revenue codes 042x, 043x and 044x must be billed with the applicable modifier codes.	182	N657
WL9	Service is not found on the fee schedule because it may be covered under the HHA episode rate, so it is not separately payable.	16	N471
WM0	The provider must submit a correct type of admission code before benefits can be provided.	16	MA41
WM1	Charge exceeds the maximum allowable under  Member’s coverage.	45
WM2	It is a subrogation adjustment. It will not affect previously assigned patient liability.	215
WM3	The provider must submit a correct disCharge status before benefits can be provided.	16	N50
WM4	The provider must submit a correct admission status before benefits can be provided.	16	MA43
WM5	Statement from/thru dates must correspond Service line dates of Service before benefits can be provided.	16	MA31
WM6	Duplicate data not allowed in 5010 formatted Claim.	18	N522
WM7	Member has other insurance; please bill the primary carrier. Claim is paid due to the Services being under the pay and chase option.	22	N598
WM8	Modifier code or Procedure code is not valid for the date of Service on the Claim.	4	N519
WM9	Service is not covered when performed with an invalid Diagnosis code.	11	N657
WMN	Payment of Claim is pending receipt of Medicaid registration.	16	MA112
WMT	Claim is on hold based on current premium information. The member should contact his or her Human Resource office.	27	N30
WN1	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	45
WN2	The only appropriate bill types for SNF Claims are 18X, 21X, 22X, and 23X.	16	MA30
WN3	Claim contains Service dates that are invalid or out of range.	16	MA31
WN4	Only one Resource Utilization Group can be billed per individual date of Service.	16	N471
WN5	SNF Part B Claims are not allowed to cross the calendar year boundary.	16	M52
WN6	Part B therapy Services billed with revenue codes 042x, 043x and 044x must be billed with the applicable modifier codes.	182	N657
WN7	Service is non-covered because authorization guidelines were not followed for  Service.	197
WN8	Claim was adjusted following an HDI provider Audit	50	N10
WN9	The Claim was adjusted following an HDI provider Audit	50	N10
WOD	Payment of  Claim is pending the receipt of a ownership and disclosure form from the rendering provider or group billing entity.	16	MA112
WP0	Call 1-800-924-7141 for Claim detail if needed.
WP1	Charge is being discounted in accordance with NPPN agreement. The member is not responsible for  amount.	45
WP2	Charge is being discounted in accordance with URN agreement. The member is not responsible for  amount.	45
WP3	Charge is discounted in accordance with MultiPlan Inc. agreement. The member is not responsible for  amount.	45
WP4	Benefits cannot be provided until the provider submits complete medical records for  inpatient admission.	252	N451
WPX	Charges for a pre-existing condition are not eligible for benefits.	51	N607
WQ0	The number of units on  line is considered Medically Unlikely.	96	N362
WQ1	Automated Multi Channel Chemistry HCPCS component codes must have only one occurrence of a CD, CE or CF modifier on each line.	16	M53
WQ2	Automated Multi-Channel Chemistry Service is not paid because less than 50% of these Services are separately payable.	234	M15
WQ3	Telehealth originating site fee, HCPCS code Q3014, is billed incorrectly.	16	M20
WQ4	Service has been paid at a user-defined percent of Charges.	169
WQ5	Claim lines for EPO and Aranesp must be billed with the proper revenue codes.	16	M50
WQ6	The HCT or HGB exceeds monitoring threshold without the appropriate modifier code.	4	N519
WQ7	Part A SNF Claims must contain at least one Resource Utilization Group Codes.	16	N471
WQ8	Part B ambulance Services must have the zip code of the location of pick-up present on the Claim.	16	N53
WQ9	Revenue code is not covered for type of bill 22x.	16	M50
WR0	Service is not covered when performed for the reported Diagnosis.	11	N657
WR1	Procedure is redundant to the primary Procedure and is limited by  Member’s plan.	234	M15
WR2	Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.	18	N522
WR3	Services performed in a school setting requires an Individualized Educational Plan.	252	M135
WR4	Medial Branch Block Injection Certification form invalid or incomplete	252	N473
WR5	The provider must file  Claim to the non-emergency transportation broker for processing.	96	N61
WR6	The provide must submit a corrected EOB from the primary insurance before benefits can be provided.	16	N4
WR7	Claim was pended due to non-payment of premium and will be denied if the premium is not pad by the end of the grace period.	200	N619
WR8	The provider must submit a corrected EOB from the primary insurance before benefits can be provided.	16	N4
WR9	is a subrogation adjustment. It will not affect previously assigned patient liability.	215
WS0	revenue code is not valid with the Diagnosis on the Claim. The provider should refer to billing guidelines.	96	N95
WS1	Submit dental Claims to DentaQuest, 11100 W Liberty Drive, Milwaukee, WI 53224.	109	N418
WS2	Claim needs to be submitted to Magellan Rx	109	N418
WS3	Claim should be submitted to Department of Medical Assistance Services.	109	N418
WS4	Consumer Directed Services are not payable for the submitted Claim. Please contact Public Partnerships, LLC, at 1-866-3009.	109	N418
WS5	These Services will need to be billed to Vision Services Plan. Please contact the vendor at 1-800-877-7195.	109	N418
WS6	Service will need to be billed to the Member’s non emergent transportation provider.	109	N418
WS8	Medical review on these DRG outlier days has been completed. The outlier days have been denied.	69
WS9	Medical records are required before outlier days will be reviewed for medical appropriateness.	252	M127
WSH	is an excluded benefit under the member’s coverage.	96	N30
WSP	specialist does not participate in your network. Please contact your PCP for a new referral.	242	N130
WT0	Benefits for abortion, sterilization or hysterectomy Services are excluded due to not meeting State or Federal requirements.	272	N584
WT1	Benefits for abortion, sterilization or hysterectomy Services are excluded due to not meeting State or Federal requirements.	272	N584
WT2	ancillary Service is not eligible for reimbursement when billed with a triage visit.	97	M86
WT3	Benefits can not be provided since the dates of Service must equal the number of units billed. The provider may file a corrected bill.	16	M53
WT4	The provider must submit a valid National Provider Identifier before benefits can be provided.	208
WT5	Emergency room Service is included in the reimbursement for the observation room.	45
WT6	Payment has already been made by another TennCare coverage for these Services. No additional reimbursement will be provided.	129	MA36
WT7	Service must be billed with a Category II code before benefits can be provided. The provider needs to file a corrected bill.	16	M51
WT8	It is not a covered Service since the primary carrier payment policies were not followed for  member.	136	N23
WTA	It is not a covered Service since the primary carrier payment policies were not followed for  member.	136	N23
WU0	Provider timely filing has been exceeded.	29
WU1	Provider timely filing has been exceeded.	29
WU2	Contracted funding agreement – Subscriber is employed by the provider of Services.	139
WU3	Contracted funding agreement – Subscriber is employed by the provider of Services.	139
WU4	Charges are eligible for Crossover or Do not match EOMB.	250	N479
WU6	The date of death precedes the date of Service.	13
WU7	The date of death precedes the date of Service.	13
WU8	Charges are eligible for processing via existing crossover arrangements.	B11
WU9	Charges are eligible for processing via existing crossover arrangements.	B11
WV0	It is a subrogation adjustment. It will not affect previously assigned patient liability.	215
WV1	Provider changed data from original Claim related to COB.	96	MA67
WV2	Line item units cannot contain a decimal.	16	M53
WV3	The provider must submit a correct occurrence code before benefits can provided.	16	M46
WV4	Claim is considered a duplicate due to a previous settlement for Medicaid Provider.	B13
WV5	Claim was adjusted following a provider audit.	50	N10
WV6	The provider must submit  patient’s medical records. Please reference  Claim number and member id when you submit the records.	252	M127
WV7	Surgical ICD Dates can’t be more than three day prior to the Statement From Date or should not be greater than the Statement To Date.	16	N301
WV8	The provider must submit appropriate Attending Physician information before benefits can be provided.	206	N253
WV9	Medical Records need to be submitted to HDI in Las Vegas for reconsideration.	50	M127
WVA	The provider must file  Claim with VA Health Administration Ctr. CHAMPVA, PO Box 65024 Denver, CO 80206-9024.	109	N36
WW0	Medical Records need to be submitted to HDI in Las Vegas for reconsideration.	50	N10
WW1	Lab Service is required to be performed by Quest Diagnostics.	242	N95
WW2	The servicing provider has billed  Claim under the incorrect patient.	96	N10
WW3	These Services are only covered when performed by the primary care provider or designee after the network discounts.	242	N450
WW4	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
WW5	Benefits for  Service cannot be reimbursed until the correct provider indicator number is billed.	16	MA134
WW6	Provider must submit medical records to better support Claim. Please reference Claim number and member id when you submit the records.	252	M127
WW7	Provider must submit medical records to better support Claim. Please reference Claim number and member id when you submit the records.	252	M127
WW8	Claim contains one or more duplicate line items to the current Claim. Please resubmit according to billing guidelines.	18	N111
WW9	Claim contains one or more duplicate line items to the current Claim. Please resubmit according to billing guidelines.	18	N111
WX0	Member incarcerated medical necessity review required.	16	M60
WX1	Line item units cannot contain a decimal.	16	M53
WX2	Claim rejected due to Member’s Medicare eligibility status; unable to apply surCharge.	137	N733
WX3	The ICD code version submitted by the provider is not compliant with Federal Regulation for  Service/disCharge date.	16	M76
WX4	Benefits for  Service cannot be reimbursed until the correct provider indicator number is billed.	16	MA134
WX5	Service is not paid in addition to or separately from the denied Service.	234	N20
WX6	The provider has not contracted to provide  Service.	45
WX7	Charge exceeds the maximum allowable under  Member’s coverage.	45
WX8	The provider must submit a valid pick up location zip code before benefits can be provided.	16	N53
WX9	Claim was pended due to non-payment of premium and will be denied if the premium is not paid by the end of the grace period.	200	N619
WY0	A corrected bill has been received. Any previous payment from  is being recouped.	96	MA67
WY1	The units of Service billed for the Procedure code exceeds the allowed number of units.	50	N362
WY2	Benefits cannot be provided until a special review is completed.	133	M127
WY3	Edit occurred because a submitted Procedure code is not valid for the Service dates on the Claim.	181	M20
WY4	Benefits cannot be provided until a special review is completed.	133	M127
WY5	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
WY6	The patient is not liable for these Charges.	133
WY7	Provider is required to enroll in the Medicaid Program where the member resides.	B7	N570
WY8	Provider is required to enroll in the Medicaid Program where the member resides.	B7	N570
WY9	Medicaid Data Elements are Missing.	252	M127
WZ0	Provider has been termed per special review completed by BlueCross BlueShield of Tennessee.	170
WZ1	Payment of Claim is pending receipt of Disclosure Form from the rendering provider or group billing entity.	16	MA112
WZ2	Claim did not meet the Tennessee Perinatal Care System for Guidelines for Regionalization, Hospital Care Levels, Staffing and Facilities.	272	N584
WZ3	Exceeds maximum units considered medically appropriate.	119	N435
WZ4	Medicare Advantage requires a completed CMS-2728-U3 form to be on file prior to adjudicating  Claim.	252	M127
WZ5	Medicare Advantage requires a completed CMS-2728-U3 form to be on file prior to adjudicating  Claim.	252	M127
WZ6	Statement from/thru dates must correspond Service line date of Service before benefits can be provided.	16	MA31
WZ7	A maximum of one Patient Assessment Form is payable each calendar year under  Member’s coverage.	119	N362
WZ8	Delivery Charges for mother and baby must be billed separately.	16	MA36
WZ9	revenue code is not valid with the Diagnosis on the Claim. The provider should refer to billing guidelines.	96	N95
WZA	Below minimum units considered medically appropriate	16	N430
WZB	Claim is being reviewed to determine if a third party payer, subrogation has liability on  Claim. Questionnaire to follow.	252	N686
WZD	Improper or inappropriate use of the modifier billed with  Procedure.	236
WZE	Routine vision Services should be filed to Eyemed for payment. Contact Eyemed for filing instructions at 1-844-261-9034.	109	N418
WZF	CMHRS Services are only billable through Magellan BH of VA. Re-submit to PO Box 1099; Maryland Heights, MO 63043.	109	N418
WZG	The Member’s Individualized Family Service Plan (IFSP) is not found or does not include  Service.	15	M62
WZH	The Member’s Individualized Family Service Plan (IFSP) is not found or does not include  Service.	15	MA62
WZI	Service can only be billed with a professional modifier code and will not be reimbursed at the global or technical rate.	234	M15
WZJ	CMHRS Services are only billable through Magellan BH of VA through 12/31/17. Re-submit to PO Box 1099; Maryland Heights, MO 63043	109	N418
WZK	Charge exceeds the maximum allowable under  Member’s coverage.	45
WZL	Service was billed on the incorrect Claim form type.	16	N34
WZM	Service was billed on the incorrect Claim form type.	16	N34
X01	The actual date of Service is needed for  Charge.	16	M52
X02	Charge should be filed at the time of delivery.	96	N56
X04	Charge has been applied to the maximum for routine Services.	96	N30
X05	The provider must submit an itemized or detailed billing before benefits can be provided for  Service.	252	N26
X06	The provider must submit the anesthesia time before benefits can be provided for  Service.	16	N203
X07	The provider must submit the name and title of the individual who rendered  Service before benefits can be provided.	16	N289
X08	The provider must submit a description of Services rendered before benefits can be provided.	252	N350
X09	principal Diagnosis code is invalid. The provider must submit a valid code.	16	MA63
X10	DRG is not paid under the Acute Care Hospital Agreement.	45
X11	Charge exceeds the maximum allowable under  Member’s coverage.	59	N644
X12	The provider has not contracted to provide  Service.	185	N684
X13	Service is not paid in addition to or separately from the primary Service.	234	N20
X14	Service is not covered for  member. The provider should submit the proper code or medical documentation.	16	MA39
X15	A valid DRG code could not be assigned for the coding that was submitted. The provider must submit valid codes.	236	N657
X16	The reimbursement for re-admission is included in the DRG allowance on a previous Claim.	97	N525
X17	The provider must submit a correct Procedure and revenue code combination before benefits can be provided.	199	N657
X18	Service is not normally performed for members in  age range.	6	N129
X19	Benefits have been reduced since the required authorization for  Service was not obtained.	197
X20	Benefits have been reduced since the required authorization for  Service was not obtained.	197
X29	modifier is not compatible with  Procedure code. The provider should submit the proper code.	4	N519
X30	Benefits cannot be determined until the provider submits the first date of dialysis.	16	MA122
X31	A split billing is needed for  confinement. The hospital must rebill according to the letter being sent to them.	96	N61
X32	The provider should refer to billing guidelines on filing days or units for Durable Medical Equipment Claims.	108	N130
X33	The Diagnosis code or Procedure code is not valid for the date of Service on the Claim.	146	M76
X34	The provider must submit the x-ray report before benefits can be provided for  Service.	252	M31
X35	The provider must file  Claim with Magellan Health Services, PO Box 2154, Maryland Heights, MO 63043 (1-800-308-4934).	109	N418
X36	The provider must refer to the billing guidelines for proper billing of patient Services.	96	N56
X37	Medical information is needed to complete a pre-existing review. Correspondence to the provider will follow.	252	N204
X38	Information has been requested from another provider to complete a pre-existing review. No action is required.	252	N204
X39	Pricing is based on a prior year agreement. The member is not liable for the amount that exceeds  pricing.	45
X40	The amount represents your Medicare savings.	23
X49	Medical records have been requested for a provider audit reconsideration.	252	M127
X50	The amount was paid by your dental policy.	23
X51	Vanderbilt employee PPO Claims must be filed with Signature Health Alliance.	109	N418
X53	Benefits cannot be provided for Services that have been determined not to be medically necessary.	50	N130
X54	Service in non-covered because authorization guidelines were not followed for  Service.	197
X55	The provider must file the Claim with CareCentrix, PO Box 277947 Atlanta, GA 30384.	109	N418
X56	Medical records have been requested for a provider audit reconsideration.	252	M127
X57	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
X58	Medicaid Data Elements are Missing.	252	M127
X60	Benefits for Services related to obesity, including surgical Procedures, are not covered under  Member’s plan.	96	N30
X76	Medical records have been requested from the provider.	252	M127
X77	The provider must submit the NDC, drug name, RX number, strength, day supply and quantity before benefits can be provided.	16	M123
X78	The provider must refer to the billing guidelines for Home Infusion Therapy. A separate line must be billed for each date of Service.	16	N61
X79	The provider must submit the appropriate CDT/CPT/HCPCS code for  Service.	189	M81
X80	Procedure requires an Origin and Destination modifier be billed. The provider should submit the proper code and modifier.	4	N519
X83	The provider must submit the proper code. No medication currently manufactured matching the code billed.	16	M119
X84	The date of birth follows the date of Service.	14
X85	The date of birth follows the date of Service.	14
X86	The provider must submit a correct Procedure and revenue code combination before benefits can be provided.	199	N657
X87	The provider must submit a correct Type of Bill and revenue code combination before benefits can be provided.	16	MA30
X88	The provider must submit a correct Procedure and place of Service combination before benefits can be provided.	5	M77
X89	The submitted Procedure is disallowed because an add on code was billed without the presence of the related primary Service/Procedure.	97	N122
X90	modifier code or Procedure code is not valid for the date of Service on the Claim.	4	N519
X91	Each per diem must be filed with any medication/injection.	16	M123
X92	Date span is not within HHA benefit week. HHA benefit week.	199	N657
X93	Date span is not within HHA benefit week. benefit week.	96	N56
X94	Each per diem must be filed with any medication/injection.	50	M51
XA1	Member’s maternity benefits include a twelve-month waiting period before benefits can be provided.	179
XA2	Completed questionnaire is needed from the member before the Claim can be processed.	133
XA3	dental Service is not eligible for benefits under  Member’s coverage.	96	N130
XA4	Service is not eligible because it was not rendered by  Member’s PCP.	185	N684
XA5	Procedure is considered investigative and is not covered under  Member’s plan.	55	N623
XA6	These Charges will be considered if a referral is submitted.	16	N335
XA7	Routine examinations are not eligible for benefits under  Member’s plan.	49	N567
XA8	Member’s coverage was not in effect on the date these Services were provided.	27	N30
XA9	Charges for a pre-existing condition are not eligible for benefits.	51	N10
XAC	Information concerning other insurance has been received and your records updated.  Claim has been adjusted.	96	MA67
XAD	The accident date or onset date is needed from the provider before benefits can be provided for these Services.	16	N305
XAT	Provider Audit Rec. – Call 423-755-5891
XAX	Self-administered drugs not covered Services under your plan.	96	N426
XB0	newborns date of birth and effective date are different, please contact the Department of Human Services.	26	N30
XB1	Member’s plan does not cover a portion of the Medicare Part B deductible.	96	N30
XB2	Benefits for  Service are excluded under  Member’s plan.	96	N30
XB3	Services for prenatal and postnatal care are not covered by  plan. Please re-file the labor and delivery Charges only.	96	N188
XB4	We are deducting  amount because of an overpayment on a previous Claim.	96	N10
XB5	Please submit a copy of the Medicare Explanation of Benefits so we can determine benefits.	252	MA04
XB6	Please submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.	252	MA04
XB7	Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.	19	N418
XB8	Your plan does not provide benefits for Services by an out of network provider.	242	M115
XB9	Benefits cannot be provided for Services not considered a medical emergency.	40
XBG	The blood gases report is needed from the provider before benefits can be provided for these Services.	252	N749
XC1	Benefits for compound drugs purchased from a non-participating pharmacy are not covered under  Member’s plan.	96	N30
XC2	The provider must file  Claim with the members home BlueCross BlueShield plan for processing.	109	N418
XC3	Please refile  Claim with the correct Explanation of Benefits from the other insurance carrier.	16	N4
XC4	Your plan does not provide benefits for Services by an out of network provider.	242	M115
XC5	The amount includes the benefits provided by  Member’s other insurance carrier.	23
XCB	Please refile  Claim with the correct Explanation of Benefits from the other insurance carrier.	16	N4
XCC	Benefits for Services related to custodial care are not provided under  Member’s plan.	96	N30
XCD	Benefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.	252	N686
XCK	Reimbursement amount applying is due to the Service not meeting medical emergency guidelines.	45
XCM	Benefits cannot be provided until the provider submits a Certificate of Medical Necessity.	252	N170
XCO	Benefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.	252	N4
XCP	Benefits for a compound prescription cannot be provided until the pharmacy supplies additional information.	16	M123
XCU	COU-Charges were reduced due to a coupon or discount applied at point of sale.	246
XD1	Charge is a duplicate of a previously submitted Charge for  member.	18	N702
XD2	We are deducting  amount because of an overpayment on a previous Claim.	96	N10
XD3	The provider must file  Claim with the members home BlueCross BlueShield plan for processing.	109	N418
XD4	Maximum benefits payable under  Member’s coverage have been provided.	119	N640
XD5	The maximum amount allowable for  equipment has been reached.	119	N640
XD6	We have paid the annual maximum allowable for these Services for  member.	119	N640
XD7	provider is not eligible under  Member’s coverage.	170
XDC	Dental Service is not eligible for benefits under  Member’s coverage.	96	N30
XDD	Member is not eligible to receive pharmacy benefits since they have Medicare Part D.	96	N30
XDE	The provider must file  Claim with DentaQuest. 12121 N. Corporate Pkwy; Mequon, WI 53092 – 1-855-418-1623.	109	N418
XDF	Expense is a duplicate of a previously submitted expense for  member.	18	N522
XDN	Newborn Charges have been denied under the subscriber’s name.  newborn is not eligible for benefits.	34
XDP	Please submit the original Medicare Explanation of Benefits showing the amount Medicare paid on  Charge.	252	MA04
XDR	A copy of all diagnostic reports for the patient is needed before the Claim can be considered.	252	N457
XDU	Duplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.	18	N522
XE1	The Charges for the 2004 dates of Service were forwarded to another BlueCross BlueShield plan for processing.	B11
XED	Please submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.	252	MA04
XEG	A copy of the EEG report with analysis is needed before the Claim can be considered.	252	M31
XEP	Service must be approved by your EAP.	197
XF0	Service is non-covered when billed by a practitioner with  specialty.	170	N95
XF1	The Claim was adjusted due to Maternity Incentive requirements were not met.	50	N10
XF2	Multiple transitional care management codes have been filed within a specific time period.	96	M86
XF3	The required modifier is missing or the modifier is invalid for the Procedure code.	16	N519
XF4	Procedure is considered a part of the global package previously paid on another Claim.	97	N525
XF5	The units billed on  Claim fall outside the range of units that are considered medically appropriate.	151	N362
XF6	The Claim was adjusted to reflect your payment to the Division of TennCare.	131
XF7	A Charge in history relating to  Procedure has been paid. Please re-file corrected bill with all necessary Charges on one Claim.	97	M15
XF8	The ambulance report is needed from the provider before benefits can be provided for these Services.	252	N745
XFB	Service is not covered because benefits for the related condition are limited by a rider to  Member’s contract.	51	N607
XFD	Contract does not provide benefits for Services intended to create a pregnancy.	96	N30
XFO	Service ordered by provider sanctioned by HHS. Federal law mandates no payment when insured by federally funded program.	185
XFS	Provider sanctioned by HHS. Patient insured by federally funded healthcare plan. Federal law mandates no payment.	185
XFT	contract does not cover infertility treatment, Services to create a pregnancy, or any resulting complications.	96	N30
XFW	It is a subrogation adjustment. It will not affect previously assigned patient liability.	215
XG0	Maximum benefits payable under  Member’s coverage have been provided.	119	N587
XH0	An intermediary handles  Service. The Claim should be filed to the intermediary.	16	N8
XH1	Charges for outpatient Services with  proximity to inpatient Services are not covered.	60	N676
XH2	It is not a covered Service unless the provider accepts assignment.	111
XH3	It is not a covered Service since appeal Procedures were not followed or time limits were not met.	138	N584
XH4	It is not a covered Service since the patient It is enrolled in Hospice.	B9
XH5	It is not a covered Service since new patient qualifications were not met.	B16
XH6	It is not a covered Service since the DiagnosIt is It is inconsIt istent with the provider type.	12	N657
XH7	Information has been requested from the member.	95
XH8	It is not a covered Service since there was a lapse in coverage.	200	N650
XH9	It is not a covered Service since prior hospitalization or thirty day transfer requirement was not met.	A6
XHA	Claim has been paid up to the Member’s local plan’s allowance.	45
XHB	is a Medicare Advantage Type Claim. Medicare Charge limitations may apply.
XHC	The payment on  Claim includes a Personal Savings Account or Health Reimbursement Account payment.	187
XHD	The Payment Direction has been changed on  Claim.
XHE	Claim is being paid in full up to the Charged amount.
XHH	The maximum home health Services under  Member’s coverage has been provided.	119	N362
XHI	The provider must submit  patient’s progress notes or progress report before benefits can be provided for  Service.	252	N393
XHJ	The provider must submit a photo or copy of  patient’s X-rays before benefits can be provided for  Service.	252	N40
XHK	The provider must submit the plan of treatment for  patient before benefits can be provided for  Service.	50	M132
XHL	The provider must submit the psychiatric testing results before benefits can be provided for  Service.	252	N467
XHM	Claim is a duplicate to a Medicare cross over Claim which was processed directly by the Member’s plan.	18	N522
XHN	The provider must submit the tooth number before benefits can be provided for  Service.	16	N37
XHO	Your plan does not provide benefits for Services by an out of network provider.	242	M115
XHP	Claim was closed without processing by the Member’s Plan.	227
XHR	Your plan does not provide benefits for Services by an out of network provider.	242	M115
XHS	Claim is a duplicate to a Medicare cross over Claim which was processed directly by the Member’s plan.	18	N522
XHT	A copy of the PET/MRI/CT Scan reports for the patient is needed before the Claim can be considered.	252	M31
XID	The contract does not cover infertility treatment, Services to create a pregnancy, or any resulting complications.	96	N30
XIF	The contract does not provide benefits for Services intended to create a pregnancy.	96	N30
XJ0	Claim needs to be filed to the Plan in whose Service area the DME equipment was shipped to or purchased at a retail store.	96	N30
XJ1	Claim needs to be filed to the Plan in whose Service area the specimen was drawn.	109	N557
XJ2	Specialty Pharmacy Claim needs to be filed to the Plan in whose Service area the ordering physician is located.	96	N30
XJ3	Claim needs to be filed to the Plan in whose Service area the DME equipment was shipped to or purchased at a retail store.	96	N30
XJ4	Claim needs to be filed to the Plan in whose Service area the specimen was drawn.	109	N557
XJ5	Specialty Pharmacy Claim needs to be filed to the Plan in whose Service area the ordering physician is located.	96	N30
XK0	is an inactive revenue code. The provider should refile with a valid code.	16	M50
XK1	The provider must submit a correct Procedure and revenue code combination before benefits can be provided.	199	N657
XK2	Medicare considered  amount as a contractual write-off and the provider cannot bill you for it.	96	M41
XK3	Charge exceeds the maximum allowable under  Member’s coverage.	45
XK4	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
XK5	The provider has not contracted to provide  Service.	96	N448
XK6	Service is not paid in addition to or separately from the primary Service.	234	N20
XK7	A maximum of one DME maintenance Service is payable every 6 months.	119	N362
XK8	The provider has agreed to accept the amount allowed under  Member’s contract for  Service.	131
XK9	Claim contains DOS that span  patient’s hospice benefit election date. Please reference applicable billing guidelines.	96	N143
XKA	Charge exceeds the maximum allowable under  Member’s coverage.	45
XL1	The maximum annual benefits payable under  Member’s coverage have been provided.	119	N587
XL2	The maximum number of Services payable under  Member’s coverage has either been met or exceeded on  Claim.	119	N362
XL3	The maximum annual benefits payable under  Member’s coverage have been provided.	119	N587
XLT	The maximum lifetime benefits payable under  Member’s coverage have been provided.	119	N587
XM1	A new Claim is being requested that meets Medicare payment guidelines. No action is required by the member.	96	N386
XM2	Member’s coverage allows hearing aids for the subscriber and dependent children only.	96	N30
XM3	Services are eligible for processing under the Medicare crossover arrangement.	22	N479
XM4	Charge is more than Medicare allows for  Service. The member is liable for  amount.	45
XMA	These Services are not covered for a dependent child under your plan.	96	N30
XMB	Please refile  Claim with the correct Medicare Explanation of Benefits.	252	MA04
XMC	Medicare coinsurance is not covered by  policy.	96	N30
XMD	Please submit a copy of the Medicare Explanation of Benefits so we can determine benefits.	252	MA04
XMF	Provider is not eligible under  Member’s coverage.	170
XMH	Policy does not provide secondary benefits when Medicare is an HMO or Choice Plan.	96	N30
XMI	Benefits cannot be provided until the provider submits additional information to complete a pre-existing review.	252	N204
XMK	Date of Service (DOS)  is prior to the effective date. The provider must file with the prior carrier.	26	N30
XMP	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
XMS	Member’s coverage was not in effect at the time of  Service.	27	N30
XMT	The timely filing limit as outlined in the Member’s contract/benefit has expired.	29
XN1	The member failed to comply with the Mandatory Case Management requirement.	272	N584
XNC	The difference between the Medicare allowance and benefit maximum is not eligible under your contract.	122
XNE	Service is being reimbursed based on the non emergency fee schedule.	45
XNF	Information is needed from the Member to complete a pre-existing review. Correspondence to the member will follow.	96	N204
XNM	Non maternity Service not covered. Maternity Only Policy. For a list of eligible maternity codes see BCBST.com	96	N30
XNN	Benefits for  Service are excluded under  Member’s plan.	96	N30
XNP	Charge exceeds the maximum allowable under  Member’s contract for a non-participating provider.	45
XNR	Benefits cannot be provided until we receive previously requested information concerning another party’s liability.	20
XOB	Your contract provides benefits for maternity Services only at  facility.	242	N130
XON	Your plan does not provide benefits for Services by an out of network provider.	242	M115
XOV	Please submit dates of Service beginning 7/1/2015 to TRH/Farm Bureau Health Plans.	27	N30
XP1	Service is denied as a pre-existing condition because symptoms existed prior to  Member’s effective date.	51	N607
XP2	Service is denied as a pre-existing condition because treatment was recommended prior to  Member’s enrollment date.	51	N607
XP3	Service is denied as a pre-existing condition because treatment as received prior to  Member’s enrollment date.	51	N607
XP4	Service is denied as pre-existing because treatment was recommended prior to  Member’s effective date.	51	N607
XP5	Service is denied as pre-existing because treatment was received prior to  Member’s effective date.	51	N607
XP6	Member’s coverage does not include benefits for congenital malformations that do not meet medical policy criteria.	96	N30
XP7	Service is not covered because benefits for the related condition are limited by a rider to  Member’s contract.	51	N607
XPA	Provider is not eligible under  Member’s coverage.	185	N684
XPB	Service is denied as a pre-existing condition because treatment prior to  Member’s enrollment date.	26	N30
XPC	Service is not eligible because it was not rendered by  Member’s PCP.	242	M115
XPD	Member’s age is beyond the limiting age for these benefits.	96	N129
XPH	Physician Services must be billed separately from the hospital Claim.	89	N200
XPI	Benefits are not provided for personal convenience items.	96	N30
XPR	A non-participating provider has been used.	242	M115
XPW	Benefits for  Service have a ninety-day waiting period.	179
XPX	Your coverage has a one-year waiting period before benefits are available for  Service.	179
XR0	Benefits cannot be provided since an authorization was not obtained for  Service.	197
XR1	Provider is ineligible to provide  pharmacy Service.	185	N684
XR2	Diabetic Testing Supplies should be provided through Pharmacy.	109	N418
XR3	Medication is not covered under the Member’s medical plan. Please contact CVS Specialty at 1-888-265-7790 for pharmacy benefits.	185	N684
XRU	BlueCross BlueShield of Tennessee no longer administers Claims for  group. Please contact employer for information.	27	N30
XRX	Member’s coverage does not provide benefits for prescribed drugs and other medications.	96	N30
XS1	Secondary benefits will be paid until day one hundred of confinement. Benefits will then be based on medical necessity.	96	N30
XSA	is money reimbursed due to another party’s payment. Refer to Patient Owes column for any liability changes.	215
XSB	The amount exceeds the Member’s liability per Health Care Financing Administration guidelines.	45
XSD	We are providing secondary benefits to your prescription drug card.	23
XSF	coverage does not provide benefits for the treatment of self inflicted injuries.	96	N30
XSH	The amount was applied to the member’s monthly patient pay.
XSI	Coverage does not provide benefits for the treatment of self inflicted injuries.	96	N30
XSM	For Services after 1/1/2000,  Claim is administered by United Behavioral Health 1-877-237-8574.	27	N30
XSN	Non-skilled nursing home visits are not a covered benefit under  plan.	B1	N30
XSR	Benefits have been reduced because a non-participating provider was used.	45
XSS	Your supplemental BlueCross BlueShield coverage does not provide benefits for these Charges.	96	N30
XSm	These Services are handled by your Behavioral Health Provider. Please have your provider refile  Claim with the appropriate carrier.	96	N30
XT1	Member’s contract does not provide benefits for contraceptives.	96	N30
XT2	Member’s contract does not provide benefits for routine maternity Services.	96	N30
XT3	Member’s coverage does not provide benefits for Temporomandibular Joint Dysfunction – TMJ.	96	N30
XTB	We have provided extended benefits for a condition that was diagnosed and treated before  Member’s policy expired.	96	N30
XTF	The timely filing limit as outlined in the Member’s contract/benefit has expired.	29
XTH	Services not eligible for Telehealth.	96	N776
XTP	Service has been reimbursed by a third party liability carrier.	20
XUC	Charge exceeds the maximum allowable under  Member’s coverage.	45
XUN	Claim was for date of Service July 1, 2015, or after, please submit to new Claims Administrator.	27	N30
XV1	Benefits for  Service are limited to one time per twelve-month period.	119	M90
XV2	Benefits for  Service are limited to one time per twenty-four month period.	119	N435
XVS	The vein study report is needed from the provider before benefits can be provided for these Services.	252	N739
XW1	Benefits for  Service have a six-month waiting period.	179
XW2	Benefits for  Service have a six-month waiting period.	179
XW3	Benefits for  Service have a sixty-day waiting period.	179
XWP	Member’s maternity rider includes a ten-month waiting period before benefits can be provided.	179
XZA	Paid according to the USA MCO/USA Senior Care Network contractual agreement.	1	N364
YAB	Claim was adjusted because the Service is eligible for benefits under the Member’s coverage.	96	MA67
YAI	Claim was adjusted because additional information was received.	96	MA67
YBC	Claim was adjusted because the provider submitted a corrected billing.	96	MA67
YBE	Claim was adjusted because we were notified that the provider billed for  Service in error.	96	MA67
YBI	Claim was adjusted to include the additional billing from the provider.	96	MA67
YCA	Cost Share – Corrected – DO NOT ADJUST.
YCB	Claim not handled as a corrected bill due to original Claim was denied	96	MA67
YCC	Claim was adjusted to correct the deductible, copay or coinsurance.	96	MA67
YCM	Claim was adjusted to provide benefits secondary to Medicare.	96	MA67
YCO	Cost Share – Corrected – Additional Payment Made.
YCP	Claim was adjusted because the Member’s BlueCross BlueShield coverage is primary.	96	MA67
YCS	Claim was adjusted to provide benefits secondary to  Member’s other insurance coverage.	96	MA67
YDD	Claim was adjusted because  Service was processed on a previous Claim.	96	MA67
YDP	Service was previously denied as a duplicate in error.	96	MA67
YEU	Claim was adjusted because the Member’s eligibility has been updated.	96	MA67
YGO	Claim was adjusted to provide corrected benefits.	96	MA67
YHC	Member has been enrolled in Contraceptive coverage. Please note new contraceptive Only identification number.
YM1	Your Claim for  date of Service is being adjusted due to an increase in Medicare’s allowed amount.	96	MA67
YM2	Claim was adjusted because  Member’s coverage has been terminated.	96	MA67
YMP	Claim was adjusted to provide corrected benefits.	96	MA67
YMR	Claim was adjusted because  Member’s coverage has been terminated.	96	MA67
YNI	Claim was adjusted to provide corrected benefits.	96	MA67
YPD	Claim was adjusted because  Service is related to a pre-existing condition.	96	MA67
YPP	Claim was adjusted because it was determined that  Service is not related to a pre-existing condition.	96	MA67
YRB	Claim was adjusted because the Service is not eligible for benefits under the Member’s coverage.	96	MA67
YRD	Claim was adjusted because  Service is related to a condition limited by a rider to  Member’s contract.	96	MA67
YSC	Claim was adjusted to provide corrected benefits under  Member’s coverage.	96	MA67
YSD	Claim was adjusted because  Service is not eligible for benefits under the Member’s coverage.	96	MA67
YSP	Claim was adjusted because  Service is eligible for benefits under  Member’s coverage.	96	MA67
YTH	Although  Member’s benefit limit has been met,  Claim has been reconsidered and adjusted pursuant to your separate mailing.	96	MA67
YUM	Claim was adjusted because the authorization for  Service has been updated.	96	MA67
YWI	Claim was previously processed under another Member’s name or ID number in error.
Z02	Agreement Discount Off Charges	45
Z05	CoverKids – Claim to apply Network S rates.
Z19	Call 1-800-276-1978 for Claim detail if needed.		MR
Z21	Call 1-800-468-9736 for Claim detail if needed.		MR
Z2B	Claim is being processed under your secondary coverage.	B11	N418
Z44	Call 1-800-468-9736 for Claim detail if needed.
Z55	Call 1-800-468-9736 for Claim detail if needed.		MR
Z57	We are investigation to determine if  condition is pre-existing. If found to be pre-existing we may seek a refund.
Z66	Call 1-800-468-9736 for Claim detail if needed.		MR
Z8A	HIPAA 835 Runbook setting CapitatedPayment	24
Z8C	HIPAA 835 Runbook setting RishWhAmt	104
Z8D	HIPAA 835 Runbook setting DentalPreDeterminationAmt	101
Z8E	HIPAA 835 Runbook setting CalculatedCdcbAdjAmt	22	N598
Z8F	HIPAA 835 Runbook setting OffsetCdcbAdjAmt	22	N598
Z8G	HIPAA 835 Runbook setting SbPymAmt	100
Z8H	HIPAA 835 Runbook setting CdcbCobAmt	23
Z8I	HIPAA 835 Runbook setting ConsiderChg	94
Z8J	HIPAA 835 Runbook setting CoinsAmt	2
Z8K	HIPAA 835 Runbook setting CopayAmt	3
Z8L	HIPAA 835 Runbook Setting DedAmt	1
Z8M	HIPAA 835 Runbook setting Inclusive	A1
Z8N	HIPAA 835 Runbook setting BundleOrigSubmChg	97	M15
Z8O	HIPAA 835 Runbook setting BundleChgsAdjustedUp	94
Z8P	HIPAA 835 Runbook setting Hra	187
ZA4	Call 1-800-468-9736 for Claim detail if needed.		MR
ZA5	Call 1-800-468-9736 for Claim detail if needed.		MR
ZA6	Call 1-800-468-9736 for Claim if needed.		MR
ZA7	Call 1-800-276-1978 for Claim detail if needed.		MR
ZA8	Call 1-800-468-9736 for Claim detail if needed.		MR
ZAS	A reduction was applied to provider Claim paid amount due to CMS Sequestration.
ZB1	Call 1-800-705-0391 if you need assistance or Claim detail.
ZCB	IT is TIME TO UPDATE INFORMATION REGARDING OTHER INSURANCE. PLEASE CALL 1-800-200-3704.	252	N686
ZCD	IT is TIME TO UPDATE INFORMATION REGARDING OTHER INSURANCE. PLEASE CALL 1-800-200-3704.	252	N686
ZCN	Payment was recommended by NCN Data isight. For questions contact www.dataisight.com or 1-800-499-9708 and select option 2.	96	N30
ZD1	These Services were not approved by your EAP.
ZD2	These Services were approved by your EAP.
ZD3	Benefits are being provided for  Claim; however, future Claims for  Diagnosis should be submitted to your EAP.
ZD5	Benefits were provided for  Claim since a free cleaning coupon was redeemed.  Service did not apply toward any annual maximum.
ZDA	Your contract provides alternate courses of treatment that must meet accepted dental standards. Benefits are reduced.
ZDK	Claim has been approved based on information provided by Duke EAP. Call 800-336-DUKE (3853) if you have any questions.
ZDN	Call 1-800-924-7141 for Claim detail if needed.
ZE1	Member’s Claim has been separated for processing. No action is required.	B11	MA15
ZF5	Manual Recovery – Call 1-800-572-1003 for details		MR
ZHF	Member’s coverage under  plan was not in effect on the date  Service was provided.	27	N30
ZMB	You may not be liable for the amount indicated in the Amount You Owe Provider field. Please verify with your provider or primary carrier.	96	N30
ZMG	Call 1-800-924-7141 for Claim detail if needed.
ZMP	The Maintenance of Benefits provision in  Member’s contract may affect liability. Please see primary carrier’s remittance for details.	96	N30
ZMR	Call 1-800-924-7141 for Claim detail if needed.
ZMS	payment is secondary to benefits provided by Medicare. In network benefits have been applied.
ZNN	In-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.
ZON	In-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.
ZOO	In-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.
ZP1	Failure to obtain a prior authorization for  Service will result in a $250.00 copay.	96	N30
ZP2	Our records indicate that you have overpaid at the pharmacy for  date of Service.
ZP3	Benefits are not payable when Medicare’s primary benefit exceeds  plan’s maximum payment. The amount owed is shown as patient liability.	96	N30
ZPA	Provider Advance Recovery
ZPS	Part D medications that are otherwise covered under the ESRD PPS bundled payment are not eligible for a separate Part D benefit payment	96	MA67
ZPX	Charges not shown on the Explanation of Benefits are in pre-existing review. No action is required.	B11	MA15
ZR1	Claim was adjusted because additional information was received.	96	MA67
ZRA	Claim was combined with a related Claim and considered as one confinement.	96	MA67
ZRB	Medical chart was not submitted for review within the required time frame.	96	MA67
ZRC	Approved orders for  inpatient stay were not included in the medical records.	96	MA67
ZRD	Charge was combined with an inpatient Claim of an affiliated hospital.	96	MA67
ZRE	A provider audit determined that  CPT code is not appropriate for the Service rendered.	96	MA67
ZRF	CPT code was added due to appropriateness.	96	MA67
ZRG	A provider audit determined that  code is a component of a more comprehensive code filed on a different Claim.	96	MA67
ZRH	Pre-admission and post-disCharge Services were combined with the inpatient Claim.	96	MA67
ZRI	A provider audit determined that  Service is considered to be part of  Member’s inpatient confinement.	96	MA67
ZRJ	Payment for pre-admission testing is included in the ambulatory surgery global fee.	96	MA67
ZRK	The medical chart indicates that a twenty-three hour observation stay was rendered instead of an inpatient stay.	96	MA67
ZRL	A provider audit determined that  code is a component of a more comprehensive code filed on the same Claim.	96	MA67
ZRM	A provider audit determined that  Service is a duplicate of another CPT code filed on the same Claim.	96	MA67
ZRN	A provider audit determined that  Service should be included in the global case payment.	96	MA67
ZS0	Call 1-800-558-6213 for Claim detail if required.		MR
ZS1	Call 1-800-558-6213 for Claim detail if required.		MR
ZS2	Call 1-800-558-6213 for Claim detail if required.		MR
ZS3	Call 1-800-558-6213 for Claim detail if required.		MR
ZS4	Call 1-800-558-6213 for Claim detail if required.		MR
ZS5	Call 1-800-558-6213 if Claim detail is required.		MR
ZS6	Call 1-800-558-6213 for Claim detail if required.		MR
ZS7	Call 1-800-558-6213 for Claim detail if required.		MR
ZS8	Call 1-800-558-6213 for Claim detail if required.		MR
ZS9	Call 1-800-558-6213 for Claim detail if required.		MR
ZSB	Call 1-800-924-7141 for Claim detail if required.		MR
ZSC	Call 1-800-468-9736 for Claim detail if required.		MR
ZSP	Call 1-800-924-7141 for Claim detail if required.		MR
ZST	Call 1-800-276-1978 for Claim detail if required.		MR
ZTB	The Claim was adjusted to reflect your payment to the Bureau of TennCare.
ZTC	Due to TennCare RAC Recovery your payment has been applied to the Claim.
ZTD	The Claim was adjusted to reflect your payment to the Bureau of TennCare.
ZTH	THCII – Review Episode of Care Report in BlueAccess.
ZTM	Previous payment.		MR
ZY1	Procedure is not covered under the Member’s current benefit plan.	204
ZYP	The required modifier is missing or the modifier is invalid for the Procedure code.	4	N519
ZYQ	Charge was denied by Medicare and is not covered on  plan. The provider can bill the patient.	96	N30
ZYR	Service is not covered when performed in  setting.	96	N428
ZYS	Procedure code is not a billable Service under  plan.	96	N431
ZYT	The benefit for  Service is included in the allowance for another Service that has already been adjudicated.	97
ZYU	The date of Service is past timely filing guidelines.	29
ZYV	Procedure was denied because it was billed by a provider with an invalid or inactive NPI number.	16	N433
ZYW	Cosurgeons need to be of a different subspecialty.	54	N646
ZYX	Each provider is reimbursed according to the portion of surgical care they provided during Procedure(s).	B20	M86
ZYY	Procedure denied due to multiple submissions for the technical or professional component of the same Procedure.	B13	M86
ZYZ	Contracted amount for Procedure is greater than submitted Charge. Payment reduced to the submitted Charge.	16	M54
ZZ1	CPT code has been denied because a more appropriate CPT code that better describes the Services rendered should be billed.	96	N56
ZZ2	Charge is a duplicate of a previously submitted Charge for  member.	18	N522
ZZ3	Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.	97	M80
ZZ4	principle Diagnosis code is invalid. The provider must submit a valid code.	16	MA63
ZZ5	Service is not normally performed for members in  age range.	6	N129
ZZ6	Service is considered part of the primary Procedure. Please do not bill separately.	97	N19
ZZ7	Service is not covered when performed on the same day as a related Procedure.	273	N435
ZZ8	Edit occurred because a submitted Procedure code is not valid for the Service dates on the Claim.	181	M20
ZZ9	A history Procedure code is within the global period of the Procedure code on  line.	96	M86
ZZA	is a bundled Service. The payment is included in the Service to which item/Service is incident.	97	M80
ZZD	There is one or more Edits present that cause the whole Claim to be denied.	96	N56
ZZE	The billed Service has been denied since the maximum units of Service allowed has been exceeded.	119	N362
ZZF	is a bundled Service. The payment is included in the Service to which item or Service is incident.	234	M15
ZZG	Price adjusted due to additional line item modifiers.
ZZH	Submitted Procedure is disallowed, mutually exclusive to other Procedure.	96	N20
ZZI	Service is a part of the original surgical Procedure and is limited by  Member’s plan.	97	M144
ZZJ	A potential overpayment has been identified on  Claim.	45
ZZL	Only postoperative portion of global payment is allowed.	45
ZZM	The single/unilateral code disallowed – billed more than once on a single date of Service. Replaced with Bilateral code.
ZZN	Non-physician assistant at surgery Services are included in the physician/facility payment.	54	N646
ZZO	The submitted Procedure is disallowed because it does not typically require a co-surgeon according to CMS Medicare guidelines.	54	N646
ZZP	The submitted Procedure is disallowed because it does not typically require a team of surgeons according to CMS Medicare guidelines.	54	N646
ZZQ	Procedure qualifies for multiple endoscopy reduction and payment should be reduced. RVU value for  line should be reduced.
ZZU	Multiple Procedures billed for the same Service date in which a reduction is applicable, per CMS guidelines.	45
ZZV	The Procedure code describes a physician interpretation for Service and is not appropriate in place of Service.	96	M97
ZZW	Claim line is being disallowed because and E and M code is within the global period with a same Diagnosis category by same provider.	97	N525
ZZX	Service is not paid in addition to or separately from the primary Service.	234	N20
ZZY	The health Service code was denied as it is not a covered Service when billed with the submitted Diagnosis code.	11	N657
E01	The submitted line is disallowed because it  was previously billed.
E02	The submitted line was submitted after the filing deadline.
E03	The submitted code is disallowed because of an invalid Procedure code.
E04	The submitted line item is disallowed because it was received after the code deletion date.
E05	The submitted code is disallowed because the Procedure is not covered.
E06	The line item is disallowed because the payment modifier and Procedure code combination is invalid.
E07	The submitted Procedure code and nonpayment modifier are disallowed because the payment modifier and Procedure code combination is invalid
E08	The submitted code is disallowed because the Procedure code is unlisted.
E09	The submitted office consultation is disallowed because it was submitted by a provider who is classified as a primary care provider.
E10	The submitted Procedure is disallowed because it does not typically require an assistant surgeon.
E11	The submitted non-anesthesia Procedure is disallowed because is not eligible to be crosswalked to an anesthesia Procedure.
E12	The submitted Procedure is disallowed because is inconsistent with the patient’s age.
E13	The submitted Procedure is disallowed because is inconsistent with the patient’s gender.
E14	The submitted Procedure is disallowed because an add on code was billed without the presence of the related primary Service/Procedure.
E15	The submitted line item is disallowed because the Diagnoses are inconsistent with the male gender.
E16	The submitted line item is being disallowed because the Diagnoses are inconsistent with the female gender.
E17	The submitted line item is being disallowed because of incomplete Diagnosis codes.
E18	The submitted line item is disallowed because of invalid Diagnosis code(s).
E19	A surgical code is billed rather anesthesia code Service disallowed. Replaced anesthesia code.
E20	A surgical code is billed rather anesthesia code Service disallowed. Replaced anesthesia code.
E21	Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date rage with previous Claims.
E22	The submitted Procedure is disallowed because is inconsistent with the patient’s gender.
E23	The submitted Procedure is disallowed because is inconsistent with the patient’s age.
E24	Submitted Procedure is disallowed since the total Procedure was previously billed. Cannot submit the professional or tech component.
E25	Submitted Procedure is disallowed, total Procedure was previously billed by another provider. Cannot submit the prof or tech component.
E26	The submitted Procedure is disallowed because CMS indicates that  Procedure is always bundled when billed with any other Procedure.
E27	Submitted Procedure is disallowed, incidental to other Procedures.
E28	Submitted Procedure is disallowed, mutually exclusive to other Procedures.
E29	Submitted Procedure is disallowed, component to other Procedures.
E30	The visis disallowed because it was billed by the same provider on the same date of Service as a code within the global period.
E31	The submitted line is disallowed because code pairs found to be unbundled according to CMS National Correct Coding Initiative.
E32	The submitted line is disallowed because the supply was submitted for the same date as a surgical Procedure.
E33	The submitted line is disallowed because code pairs found to be unbundled according to CMS Outpatient Code Editor.
E34	The submitted line is disallowed because the visit was billed by the same provider within the Procedure’s preoperative period.
E35	The submitted line is disallowed because the visit was billed by the same provider within the Procedure’s postoperative period.
E36	The submitted line is disallowed, primary Service billed with a quantity greater than one, rather than appropriate addon code.
E37	The submitted Procedure is disallowed because it was submitted more than once per date of Service.
E38	The submitted Procedure is disallowed because it was submitted more than once per date of Service.
E39	The submitted quantity is replaced since it exceeded the maximum number of times allowed on a single date of Service.
E40	The submitted Procedure is disallowed because the Procedure has already been billed with a modifier 50 for the same date of Service.
E41	The submitted Procedure is disallowed because the Procedure is not payable without immunization code billed on the same date of Service.
E42	The payment for  Procedure was reduced based on CMS multiple radiology Procedure cutback guidelines.
E43	The submitted Procedure is disallowed; a single more comprehensive code that more accurately represents the Service performed was added.
E44	The single/unilateral code disallowed – billed more than once on a single date of Service. Replaced with Bilateral code.
E45	The visit/outpatient consultation code is disallowed – billed at an inappropriate level. Replaced with Unlisted E and M.
E46	The inpatient consultation code is disallowed – billed at an inappropriate level. Replaced with Unlisted E and M.
E47	The submitted new patient Procedure is disallowed for an established patient.. Replaced with Established code
E48	Multiple surgical Procedures identified. Modifier 51 added.
E49	The submitted line modified to include modifier 26, denoting professional component performed at noted place of Service.
E50	Pay percent cutback applied
E51	The submitted Procedure is disallowed based on CMS Status Code Payment guidelines.
E52	The submitted Procedure is disallowed based on CMS Medicare Status Code Guidelines
E53	The submitted Procedure is disallowed because it does not typically require an assistant surgeon according to CMS.
E54	The submitted Procedure is disallowed because it does not typically require an co-surgeon according to CMS Medicare guidelines.
E55	The submitted Procedure is disallowed because it does not typically require a team of surgeons according to CMS Medicare guidelines.
E56	The DME Service is disallowed because it classified as Frequently Serviced in the DMEPOS fee.
E57	The DME replacement is disallowed because it classified as Frequently Serviced in the DMEPOS fee.
E58	The item is classified as rented and the Service is included in the rental fee.
E59	The DME Service disallowed. Special CMS coverage instructions apply.
E60	The submitted modifier is not a valid CPT or HCPCS modifier.
E61	The line item is disallowed because the modifier and Procedure code combination is invalid according to CMS.
E62	The submitted Procedure is disallowed because it is not recommended for payment based on CMS National Coverage Lab Policy.
E63	The submitted Procedure is disallowed because it is not recommended for payment based on CMS National Coverage Lab Policy.
E64	The Claim line is disallowed because the Diagnosis is inconsistent with the patient’s age.
E65	Procedure is disallowed because other payable Services under the physician fee schedule are billed on same date by same provider
E66	The DME item is disallowed because it was submitted for maintenance and servicing and is currently rented or beneficiary owned
E67	The DME item is disallowed because it was submitted for maintenance
E68	The DME item is disallowed because it was submitted for maintenance and servicing and is currently rented or beneficiary owned
E69	The DME item is disallowed because the item was purchased new and is beneficiary owned. Rental payments should not be submitted.
E70	The DME item disallowed because the item was purchased new and is beneficiary owned. Payments should not be submitted for owned DME item
E71	The DME item is disallowed because the maximum payment for the DME item was exceeded
E72	Allowed Procedure represents remaining MUE amount that can be paid. The submitted Procedure disallowed.Quantity billed was over MUE limit
E73	Allowed Procedure represents remaining MUE amount that can be paid. Multiple Procedures disallowed. Quantity billed was over MUE limit
E74	The submitted facility code is disallowed because the Procedure is not covered.
E75	The submitted revenue code is an invalid revenue code.
E76	Represents more appropriate code for the patient’s age than submitted Procedure code. Submitted code denied.
E77	Procedure is disallowed because component was previously billed.
E78	Submitted payment modifier and Procedure code combination is invalid. Line disallowed.
E79	Submitted non-payment modifier and Procedure code combination is invalid.Line disallowed.
E80	The DME item is disallowed because the maximum payment amount for the item has been exceeded in history or on the current Claim.
E81	The submitted Procedure is disallowed because it was submitted more than once per date of Service.
E82	The submitted quantity is replaced since it exceeded the maximum number of times allowed on a single date of Service.
E83	The single/unilateral code disallowed – billed more that once on a single date of Service.
E84	Revenue code is disallowed because a required HCPCS code was not submitted.
E85	Observation revenue code is disallowed because a required HCPCS code was not submitted.
E86	Procedure is disallowed because a E code was submitted as the primary Diagnosis.
E87	Submitted quantity greater than 1 on bilateral Procedure with history with history Claims. Replaced with quantity of one
E88	Submitted quantity exceeds MUE limit. Remaining allowed MUE quantity shown.
E89	Remaining MUE allowed amount. One or more submitted Claim lines were disallowed because the quantity billed was over the MUE limit.
E90	Submitted Procedure is disallowed because it was submitted without modifier -27.
E91	Submitted facility Procedure is disallowed because it is incidental to another submitted.
E92	Submitted Procedure is disallowed because it was submitted without modifier CA or exceeds quantities allowed.
E93	Submitted Procedure is disallowed because it was submitted submitted without modifier 91
E94	Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date range.
E95	Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date range.
E96	Submitted Procedure is disallowed because it is considered to be non-covered based on health plan medical and /or payment policy.
E97	Submitted Procedure is disallowed because related Services were previously also disallowed.
E98	Submitted Procedure is disallowed because it is not listed on the CMS NCD covered list for the submitted Diagnosis.
E99	Submitted Procedure is disallowed because it is listed on the CMS NCD not-covered list for the submitted Diagnosis.
P01	A required Procedure code or modifier is missing or invalid on the current line or an associated Claim line	16	M67
P02	The patient’s age or gender conflicts with the Procedure and/or Diagnosis code.	16	M51
P03	A Diagnosis code which meets medical necessity for  Procedure code is missing or invalid	16	M76
P04	Documentation or authorization is required to be submitted and/or reviewed.	197
P05	is a possible duplicate Claim line of another Claim line in history	18	N111
P06	E/M Procedure code is inappropriately reported for an established or new patient.	16	N657
P07	The units have exceeded the allowable maximum frequency per time span	119	N640
P08	The required modifier is missing or the modifier is invalid for the Procedure code	4
P09	is a non-covered, restricted, reporting only or bundled Procedure code or Service	96	N130
P10	The place of Service code is missing or invalid for the Procedure code	16	M77
P11	The provider specialty is missing or invalid for the place of Service or Procedure code	8
P12	A Procedure reduction should be applied to  Claim line based on the Procedure code or modifier submitted	59
P13	The type of bill, Procedure code, or revenue code are conflicting	16	N657
P14	The Procedure code has an unbundle relationship with another Procedure on  Claim or on a Claim in history	97	M15
P15	Claim or Claim line is missing information which is needed for Editing	16	M84
P16	There is a conflict with the occurrence, value or condition code and the Procedure, revenue code or TOB on the Claim	16	N657
P17	A potential overpayment has been identified on  Claim	97
S01	The patient status is not valid.	16	MA43
S02	The patient status code is missing.	16	MA43
S03	Procedure code is limited coverage code.	16	N657
S04	Procedure code is limited coverage since there is an associated limited Diagnosis code on the Claim.	16	N657
S05	Procedure codes 02RK0JZ and 02RL0JZ are limited coverage when Z006 Diagnosis code is present.	16	N657
S06	The Other Diagnosis code indicates that a wrong Procedure was performed.	11	MA63
S07	The Principal Diagnosis code indicates that a wrong Procedure was performed.	11	MA63
S08	Procedure code 9672 should not be reported when the patient’s length of stay is less than four days	16	N657
S09	Non-exempt facility submitted admission Diagnosis with Hospital Acquired Condition	233
S10	Non-exempt facility submitted principle Diagnosis code with Hospital Acquired Condition	233
S11	Non-exempt facility submitted Non-exempt Diagnosis w/POA of 1 or X	16	N434
S12	The Principal Diagnosis code requires a non-exempt POA indicator of 1 or X	16	N434
S13	The Other Diagnosis code requires a non-exempt POA indicator of 1 or X	16	N434
S14	Non-exempt facility submitted other Diagnosis code with Hospital Acquired Condition	233
T01	Edit occurred because the Procedure code requires a specific modifier when billed at  place of Service.
T02	The required Procedure code is missing according to a Local Coverage Determination.	16	M51
T03	The provider specialty does not meet criteria for the Procedure code according to a Local Coverage Determination.	8	MA130
T04	Add-on Procedure code billed with primary Procedure on Claim-Id Line.	16	MA66
T05	History Procedure Code has incidental relationship with  Procedure code.	97	M80
T06	LCD/NCD – Policy requirements are not met for Procedure code.
T07	The Diagnosis on the line is inconsistent with the Procedure according to a Local Coverage Determination.	11	N657
T08	Edit occurred because the Procedure has a profile relationship according to the Local or National Coverage Determination.	96	N386
T09	Procedure requires documentation according to a Local Coverage Determination.	252	M127
T10	Add-on Procedure is not eligible when the primary Procedure is not eligible.	B15	N674
T11	Bilateral Procedure reduction.	59	N670
T12	Procedure code and history Procedure code indicate multiple imaging Services. A 25% reduction of the technical component applies.	59
T13	Procedure code and history Procedure code indicate multiple imaging. 25% reduction of the technical component applies.	59
T14	Procedure is missing an appropriate modifier when related to an evaluation and management visit in patient history.	4	N519
T15	Procedure is missing an appropriate modifier when billed with an evaluation and management code.	4	N519
T16	Procedure qualifies for multiple endoscopy reduction and payment should be reduced. RVU value for  line should be reduced.
T17	For Procedure code and history code a multiple endoscopy reduction applies to the history Claim and payment should have been reduced.
T18	The maximum frequency for  Procedure code has been exceeded.	119	N362
T19	A multiple Procedure reduction of 50 percent of the allowed amount should be applied to  Claim line.	59	N670
T20	An operative report must be reviewed when more than 5 Procedures have been performed on the same date of Service.	252	M29
T21	A multiple Procedure reduction of 50% of the allowed amount should be applied to History Claim.	59
T22	An add on Procedure code has been submitted without the appropriate primary Procedure.	B15	N122
T23	Procedure code is a non-covered Service per the Non-covered Service list.
T24	Add-on Procedure code has been submitted without an appropriate primacy Procedure code.	B15	N122
T25	Procedure Code has an incidental relationship with another Procedure code.	97	M80
T26	Only intraoperative portion of global payment is allowed.	59
T27	Only postoperative portion of global payment is allowed.	59
T28	Only preoperative portion of global payment is allowed.	59
T29	Only intraoperative portion of global payment is allowed.	59
T30	Per Medically Unlikely Edits, the units of Service billed for  Procedure code exceeds the allowed units.	96	N362
T31	The presence of an anesthesia modifier indicates a reduction in payment.	59
T32	Anesthesia code on  line requires an appropriate modifier.	4	N519
T33	Edit occurred because a professional component modifier is needed for  place of Service for  diagnostic Procedure code.	4	N519
T34	The Procedure code describes the physician Service. Use of modifier ZY is not appropriate.	4	N519
T35	Procedure code describes only the technical portion of a Service or diagnostic test. Modifier ZY is not appropriate.	4	N519
T36	The Procedure code describes the global code of a Service or diagnostic test. Modifier ZY is not appropriate.	4	N519
T37	The Procedure code describes a physician interpretation for Service and is not appropriate in place of Service.	96	M97
T38	The Procedure code is a Service covered incident to a physician’s Service and modifier XY is not appropriate.	4	N519
T39	The Procedure code is a Service covered incident to a physician’s Service and modifier YZ is not appropriate.	4	N519
T40	The use of a modifier is not typical for the billed Procedure.	4	N519
T41	Procedure was performed on the same day of a history Procedure by the same provider. The Diagnosis indicates same condition.	96	M86
T42	Items that do not have a physician order or prescription are not covered.	173	N667
T43	The ESRD Supply HCPCS code billed is not Payable to DME Suppliers.	96	N95
T44	The maximum frequency for the DME Procedure code has been exceeded	96	N435
T45	The Procedure was performed on the same day of a history Procedure by the same provider. The Diagnosis indicates condition	96	M86
T46	A Diagnosis code or codes which meets medical necessity for the Procedure code is missing or invalid.	146	M76
T47	A history Procedure code by the same provider is in the global period of the Procedure code for the same condition	96	M86
T48	A Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.	146	M76
T49	All Claim lines on the same Claim must contain the modifier EY.	4	N519
T50	Modifier GK cannot be submitted alone, another line with GA or GZ must be present on the same Claim.	4	N519
T51	Item or Service statutorily excluded or does not meet the definition of any Medicare benefit.	4	N519
T52	The Procedure code is a non covered code or the modifier is a non covered modifier.	16	N657
T53	These are non-covered Services because  is not deemed a medical necessity by the payer.	50
T54	A Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.	146	M76
T55	In the absence of injury or direct exposure, preventive immunization and its administration is not covered.	50	N130
T56	A history Procedure code is within the global period of the Procedure code on  line	96	M86
T57	The date of Service is past timely filing guidelines.	29
T58	The units of Service billed for the Procedure code exceed the allowed number of units.	50	N362
T59	Per NCCI Edits, the a history Procedure has an unbundle relationship with the Procedure code	97	M80
T60	Per NCCI Edits, the Procedure code has an unbundle relationship with a code in history	97	M80
T61	And ICD-9 Diagnosis code in history was compared to an ICD-10 Diagnosis code on the current Claim.
T62	The Diagnosis code and modifier combination are inappropriate
T63	The Procedure code has an unbundle relationship with a history Procedure code.	97	M80
T64	A history Procedure code has an unbundle relationship with the code on the current line	97	M80
T65	The frequency of the Procedure code has exceeded the allowable maximum frequency for  code	119	N435
T66	Procedure is identified as an ambulance code and requires an ambulance modifier	4
T67	The presence of modifier GZ indicates  is not eligible for payment.	96	N30
T68	Procedure indicate multiple imaging Services were performed. Per CMS, a 25% reduction of the professional component applies.	59
T69	Procedure indicate that multiple imaging Services were performed. Per CMS, a 25% reduction of the professional component applies to history.	59
T70	A multiple Procedure reduction should be applied to  Claim line	59
T71	Based on  Claim line, a multiple Procedure reduction should be applied to history	59
U99	Claim requires configuration review.	133
W01	Invalid Diagnosis code unnecessary 4th/5th digit for patient’s admission on/disCharge date.	146	M76
W02	Invalid Diagnosis code missing 4th/5th digit for patient’s admission/ disCharge date.	146	M76
W03	Invalid Procedure code. Not found on table of valid ICD-CM codes.	16	M51
W04	Invalid Procedure code. Unnecessary 4th digit.	16	M51
W05	Invalid Procedure code. Missing 4th digit.	16	M51
W06	Invalid Procedure code. Found on ICD-CM table but not valid for patient’s admission/disCharge date.	16	M51
W07	Invalid Procedure code. Unnecessary 4th digit for patient’s admission/ disCharge date.	16	M51
W08	Invalid Procedure code. Missing 4th digit for patient’s admission/ disCharge date.	16	M51
W09	Claim lacks required HCPCS Level II code for radiopharmaceutical drug.	16	M20
W10	Revenue codes 381 and 382 can only be used when billing for packed red blood cells and whole blood.
W11	Non-approved partial hospitalization mental health Services cannot be submitted with a bill type of 13X and condition code 41.
W12	Approved partial hospitalization mental health Services submitted with TOB 12X, 13X or 14X must have condition code 41 on the Claim.
W13	The Charged amount for HCPCS code C9898 cannot exceed $1.01.
W14	Service was provided after the end date of the approved coverage in the national coverage determination.
W15	Only whole blood revenue codes can be used when billing for whole blood.	16	M50
W16	HCPCS code is not approved for a partial hospitalization Claim.	16	M51
W17	HCPCS code can only be billed on a partial hospitalization Claim.	16	M51
W18	The Charge on  line exceeds the token Charge $1.01.	16	M54
W19	Service was provided after the end date of coverage for the National Coverage Determination Policy.	96	N386
W20	Service is denied per Medically Unlikely Edits, the units billed exceed the allowable units for  code.	96	N362
W21	Per LCD or NCD, the patient’s age does not meet policy requirements for the Procedure code and/or Diagnosis code.	6	N115
W22	Per LCD or NCD guidelines, at CTP/HCPCS code is needed to meet policy requirements.	96	N115
W23	Per LCD or NCD guidelines, Procedure code has a denied relationship.	96	N115
W24	Per LCD or NCD, the frequency does not meet policy requirements for the Procedure code.	96	N115
W25	Per LCD or NCD, the patient’s gender does not meet policy requirements for the Procedure code and/or a Diagnosis code.	7	N115
W26	Per LCD or NCD guidelines, a Diagnosis code(s), which meets medical necessity for the Procedure code is missing or invalid.	96	N115
W27	Per LCD or NCD guidelines, a modifier, which meets medical necessity for the Procedure code is missing or invalid.	96	N115
W28	Per LCD or NCD, the condition code is missing or does not meet policy requirements for the Procedure code.	96	N115
W29	Per LCD or NCD guidelines, a primary Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.	96	N115
W30	Per LCD or NCD guidelines, Procedure code has a profiled relationship. Please review the policy.	96	N115
W31	Per LCD or NCD guidelines, documentation should be requested or reviewed for the Procedure code	96	N115
W32	Per LCD or NCD guidelines, a secondary Diagnosis code, to meet medical necessity for the Procedure code, is missing or invalid.	96	N115
W33	Per LCD or NCD guidelines, a tertiary Diagnosis code, to meet medical necessity for the Procedure code is missing or invalid.	96	N115
W34	Per LCD or NCD, the revenue code does not meet policy requirements for the Procedure code.	96	N115
W35	Per LCD or NCD, the type of bill does not meet policy requirements for the Procedure code.	96	N115
W36	Per LDC or NCD, the value code is missing or does not meet policy requirements for the Procedure code.	96	N115
W37	Per Medically Unlikely Edits, the units of Service billed for the Procedure code exceed the allowed units	50	N362
W38	Per NCCI Edits, a history Procedure has an unbundle relationship with the Procedure code on  line	97	M80
W39	Per NCCI Edits, the Procedure code has an unbundle relationship with one in history	97	M80
W40	The Statement Covers Period Through Date of Service is past the facility timely filing limit.	29
W41	An ICD-9 Diagnosis code in history was compared to an ICD-10 Diagnosis code on the current Claim.	96	N569
W42	The HCPCS add-on code 33225 is lacking a required primary code on the Claim.	234	N122
W43	Procedure code must be submitted with required device or Procedure code on the same date of Service.	16	M20
W44	Review the conditional or independent bilateral Procedure code for possible payment adjustment	59	N644
W45	Procedure code is retained from the transfer relationship	P14
W46	History Procedure code is retained from the transfer relationship	P14
W47	The units have exceeded the allowable maximum frequency per time span	119	N640
W48	The units including history have exceeded the allowable maximum frequency per time span.	119	N640
W49	The units have exceeded the allowable maximum frequency per time span	119	N640
W50	The units have exceeded the allowable maximum frequency per time span	119	N640
W51	Multiple Procedures billed for the same Service Date in which a reduction is applicable, per CMS guidelines.	59	N644
W52	Procedure Code should be denied due to a rebundle into another code	97	M80
W53	History Procedure should be denied due to a rebundle into another code	97	M80
W54	The surgical Procedure code contains a termination modifier, and all other Services on  Claim should be denied based on CMS guidelines.	97	M80
W55	The surgical Procedure code contain a terminated modifier and should be reviewed for a 50% reduction.	59
W56	Bundled codes transfer into new Procedure to be added to  Claim	59
W57	Age and gender conflict; the Admission Diagnosis code is not permissible for the patient’s age and gender	16	MA65
W58	Age and gender conflict; the Other Diagnosis code is not permissible for the patient’s age and gender.	16	M64
W59	Age and gender conflict; the Principal Diagnosis code is not permissible for the patient’s age and gender.	16	MA63
W60	The Admission Diagnosis code is invalid because it has an incomplete number of digits.	16	MA65
W61	The Admission Diagnosis code is invalid	16	MA65
W62	The Admission Diagnosis code is missing	16	MA65
W63	The Other Procedure code is invalid based on the Admission date	16	M67
W64	The Other Diagnosis code is invalid because it has an incomplete number of digits.	16	M64
W65	The Other Procedure code must contain a fourth or fifth digit in order to be valid.	16	M64
W66	The Other Diagnosis code must be valid and is effective based on the through date on the Claim.	16	M64
W67	The Other Procedure code must be in the ICD-PSC code Table.	16	M67
W68	The Other Procedure code contains an unnecessary digit.	16	M67
W69	The Principal Procedure code must be valid and is effective based on the admission date on the Claim.	16	MA66
W70	The Principal Diagnosis code does not contain a complete number of digits.	16	MA63
W71	The Principal Procedure code must be complete in order to be valid.	16	MA66
W72	The Principal Diagnosis code is not valid based on the through date on the Claim.	16	MA63
W73	The Principal Procedure code must be in the ICD-PSC code Table.	16	MA66
W74	The Principal Diagnosis code is missing on the Claim	16	MA63
W75	The Principal Procedure code contains an unnecessary digit.	16	MA66
W76	The Other Diagnosis code is a duplicate of the Principal Diagnosis code	16	MA64
W77	The Other Diagnosis code is a duplicate of another Other Diagnosis code on the Claim.	16	M64
W78	Age conflict; the Admission Diagnosis is not permissible for the patient’s age.	9
W79	Age conflict; the Other diagnoses is not permissible for the patient’s age.	9
W80	Age conflict; the Principal Diagnosis is not permissible for the patient’s age.	9
W81	Gender conflict; the patient’s gender and Admission Diagnosis code, on the Claim are not permissible.	10	N657
W82	Gender conflict; the patient’s gender and other Diagnosis code, on the Claim are not permissible.	10	N657
W83	Gender conflict; the patient’s gender and Other Procedure code on the Claim are not permissible.	7
W84	Gender conflict; the patient’s gender and Principal Diagnosis code, on the Claim are not permissible.	10	N657
W85	Gender conflict; the patient’s gender and Principal Procedure code, on the Claim are not permissible.	7
W86	Manifestation codes cannot be used as the Admission Diagnosis.	16	MA65
W87	Manifestation codes cannot be used as the Principal Diagnosis.	16	MA63
W88	Principal Diagnosis code indicates a questionable admission.	16	MA63
W89	Diagnosis code is unacceptable as a principal Diagnosis unless a required secondary Diagnosis is included on the Claim.	16	MA63
W90	Diagnosis code is unacceptable as a principal Diagnosis.	16	MA63
W91	An E-code cannot be used as the Admission Diagnosis code.	16	MA65
W92	An E-code cannot be used as the Principal Diagnosis code.	16	MA63
W93	A non-covered over age 65 ICD Procedure code is on the Claim and the patient is older than 60 years of age.	6	N129
W94	Procedure code is non-covered when a designated Diagnosis code is present.	11
W95	Procedure code is non-covered unless the exemption ICD Procedure code or exemption ICD Diagnosis code is present.	96	N30
W96	Claim contains Procedure codes that may be bilateral Procedures: The documentation for Procedures, should be reviewed.	16	N657
W97	Age invalid. Must be in range 0-124 years.	16	N329
W98	The patient gender is missing.	16	MA39
W99	The Patient Gender is invalid. Gender must be M, F, or U.	16	MA39
X01	Information only – linked OCE Edit 6
X02	Information only – linked to OCE Edit 6.
X03	Information only – linked to OCE Edits 16 and 17.
X04	Information only – linked to OCE Edits 16 and 17.
X05	Information only – linked to OCE Edits 16 and 17.
X06	Information only – linked to OCE Edits 16 and 17.
X07	Edit indicates that Services essential to a Procedure should not be separately coded.	234	M15
X08	Edit indicates that Services essential to a Procedure should not be separately coded.	234	M80
X09	Procedure is considered part of a more comprehensive Procedure. The provider should submit the proper code.	234	M15
X10	Procedure is considered part of a more comprehensive Procedure. The provider should submit the proper code.	234	M80
X11	Procedure is considered part of a more comprehensive Procedure for  site. The provider should submit the proper code.	B15	M51
X12	Procedure is considered part of a more comprehensive Procedure for  site. The provider should submit the proper code.	B15	M80
X13	Edit indicates that with and without codes should not be used together.	50	M51
X14	Edit indicates that with and without codes should not be used together.	B15	M80
X15	Edit indicates that anesthesia should not be reported separately when administered by the operating physician.	194	M80
X16	Edit indicates that anesthesia should not be reported separately when administered by the operating physician.	194
X17	Edit indicates that individual lab tests should not be reported separately when a lab panel exists.	97	M15
X18	Edit indicates that individual lab tests should not be reported separately when a lab panel exists.	97	M15
X19	Edit indicates that only the code for the more invasive Service should be reported.	50	M51
X20	Edit indicates that only the code for the more invasive Service should be reported.	50	M51
X21	Preparation or monitor Services that are integral to performance of the Procedure should not be coded in addition to the Procedure.	234	N390
X22	Preparation or monitor Services that are integral to performance of the Procedure should not be coded in addition to the Procedure.	234	M15
X23	These codes should not be reported together per Current Procedural Terminology coding guidelines.	16	M81
X24	These codes should not be reported together per Current Procedural Terminology coding guidelines.	16	M81
X25	These codes should not be reported together per Current Procedural Terminology coding guidelines.	16	M81
X26	These codes should not be reported together per Current Procedural Terminology coding guidelines.	16	M81
X27	Certain Services are not typically performed together.	234	N20
X28	Certain Services are not typically performed together.	234	N20
X29	These codes indicate Mutually Exclusive Services considered reasonably impossible or improbable to perform on same patient at same time.	231
X30	Codes indicate Mutually Exclusive Services considered reasonably impossible or improbable to perform on same patient at the same time.	231
X31	Two codes with opposing sex designations cannot be reported for the same patient visit.	7
X32	Two codes with opposing sex designations cannot be reported for the same patient visit.	108	N370
X33	Supporting information for OCE/Mutually exclusive Procedure Edits 019MEP.
X34	Supporting information for OCE/Mutually exclusive Procedure Edits 020CCP.
X35	Information only – An appropriate modifier on code 1 or code 2 may affect Edit.
X36	Claim contains a statutory denied Diagnosis and will be denied by Medicare.	96	N425
X37	Procedure code is not valid or not valid for the Service date on the Claim line.	181
X38	Procedure code is not valid or not valid for the Service date on the Claim line.	181
X39	Procedure code not currently covered.	96	N425
X40	Procedure code is not covered based on a statutory requirement.	96	N425
X41	Service does not have a supporting Diagnosis Code under applicable medical necessity policy requirements.	50	M26
X42	Code violates age requirements of an applicable Local or National Coverage Determination Policy.	96	N115
X43	Code violates age requirements of an applicable Local or National Coverage Determination Policy.	6	N115
X44	Code violates gender requirements of an applicable Local or National Coverage Determination Policy.	7	N115
X45	Code violates sex contrains of applicable medical necessity policy LCD or NCD, or the patient sex on Claim is missing or invalid.
X46	Service lacks the required accompanying Procedure according to a Local or National Coverage Determination Policy.	96	N115
X47	Service lacks the required accompanying Procedure according to a Local or National Coverage Determination Policy.	96	N115
X48	Age invalid; not in range 0-124 years.	50	N129
X49	Edit occurred because the sex is invalid. It is not 1 or 2, M or F.	16	MA39
X50	Invalid disCharge disposition/patient status.	16	N50
X52	An emergency code cannot be used as a principal Diagnosis.	146	MA63
X53	A manifestation code cannot be used as principal Diagnosis.	146	MA63
X55	The principal Diagnosis is invalid. The principal Diagnosis indicates questionable admission.	146
X56	The principal Diagnosis is invalid. It is an unacceptable principal Diagnosis.	146	MA63
X57	The principal Diagnosis is invalid because it is without the required secondary Diagnosis.	146	MA63
X58	Principal Diagnosis suggests surgery but there are no O R Procedure codes on  Claim.
X59	Edit occurred because all operating room Procedure codes on  Claim are non-specific.
X60	Two or more different bilateral joint Procedures are present on the Claim.
X61	Admit DX code not found on table of valid ICD-CM codes or missing/ unnecessary 4th/5th digit.
X62	The patient age and Diagnosis are inconsistent.	10	N657
X63	The patient gender and Diagnosis are inconsistent.	10	N657
X64	The patient age and sex are inconsistent with the patient Diagnosis.	10	N657
X65	Insurer may be secondary payer to Auto Insurance, Worker’s Comp, etc.
X66	An emergency Diagnosis code cannot be used as an admitting Diagnosis.	146	MA65
X67	A manifestation code cannot be submitted as admitting Diagnosis.	146	MA65
X68	Dx not found on the table of valid ICD-CM codes or missing/unnecessary 4th/5th digit.
X69	Diagnosis code is a duplicate of the principle Diagnosis.	146	MA63
X70	The patient age and Diagnosis are inconsistent.	10	N657
X71	The patient age and sex are inconsistent with the patient Diagnosis.	10	N657
X72	The patient age and sex are inconsistent with the patient Diagnosis.	10	N657
X73	Diagnosis code suggests that insurer may be secondary payer to Auto Insurance, Workers’ Comp, No Fault, etc.
X74	Diagnosis code is a duplicate of another secondary Diagnosis code on  Claim.	146	M64
X75	Proc not found on table of valid ICD-CM codes or missing/unnecessary 4th/5th digit.
X76	The patient gender and Procedure are inconsistent.	7	N115
X77	Procedure is not covered.	96	N30
X78	Edit occurred because an open biopsy code was used when a closed biopsy code may be more appropriate.
X79	Procedure is covered in limited circumstances only.	59
X80	Identifies bilateral Procedures.
X81	DOS to Units Discrepancy for Facility.
X82	The units are greater than one for a bilateral Procedure with modifier 50.	16	M53
X83	Modifier FB submitted for a Service which is not assigned to payment status S or T or V or X.	4	N519
X84	Revenue code 068X and Procedure code 99291 not submitted on the same date of Service as G0390.	199	N657
X85	The Claim lacks allowed accompanying Procedure code for device.	16	M51
X86	Edit occurred because  Claim is a possible duplicate of another Claim.	18	N522
X87	Occurred because the Principal ICD Procedure Code is invalid, has a missing date, or has an invalid date.
X88	ICD-CM Diagnosis that is denied based on statutory exclusion.
X89	Proposed alternate closed biopsy code.	59
X90	Edit occurred because the admitting Diagnosis code is invalid.	16	MA65
X91	Edit occurred because the admitting Diagnosis code is invalid It contains an unnecessary 4th or 5th digit.	16	MA65
X92	Edit occurred because the admitting Diagnosis code is invalid. It has a missing 4th or 5th digit.	16	MA65
X93	Invalid patient admission date DX the patient admission date.	146	MA65
X94	Invalid DOA DX, 4th/5th digit date of admission. It contains an unnecessary 4th or 5th digit.	146	MA65
X95	Invalid DOA DX missing digit 4,5 date of admission. It has a missing 4th or 5th digit.	146	MA65
X96	Edit occurred because an invalid Diagnosis code cannot be found on table of valid ICD-10-CM codes.	16	M76
X97	Edit occurred because the Diagnosis code is invalid. It has an unnecessary 4th or 5th digit.	16	M76
X98	Edit occurred because the Diagnosis code is invalid. It has a missing 4th or 5th digit.	16	M76
X99	Edit occurred because an invalid Diagnosis code was found on ICD-CM table but is not valid for patient admit or disCharge date.	146	M76
Y01	The account ID field is missing or invalid.	16	N382
Y02	The BDSf Edit validates the Service Date at the line level.
Y03	The FTD Edit validates the Admission and DisCharge Dates at the Claim Level.	16	M52
Y04	The CCA Edit verifies that the condition codes on the Claim are valid.	16	M44
Y05	The PSC Edit identifies Claims that are missing or contains an invalid Patient DisCharge Status Code.	16	MA43
Y06	The REV Edit identifies line items that contain missing or invalid Revenue Codes.
Y07	The TOB Edit identifies Claims that are missing or contains an invalid Type of Bill.	16	MA30
Y08	The VAL Edit confirms that the Value Codes on the Claim are valid.	16	M49
Y09	The ICMf Edit validates that the Claim contains the required primary Diagnosis prior to HSS processing.	16	MA63
Y10	The Claim has a missing Patient ID. Analysis cannot be performed without a Patient ID.	16	N382
Y11	The DOBf Edit identifies a Claim that has a missing or invalid DOB. Certain Edits cannot be performed without the patient DOB.	16	N329
Y12	The PSXf Edit identifies a Claim with a missing or invalid patient gender. Certain Edits cannot be performed without the patient gender.
Y13	Edit identifies a Claim missing a Provider ID. Analysis cannot be performed without a Provider ID.	207	N257
Y14	The IPA Edit validates that the ICD Procedure codes on the Claim are valid.
Y15	The OCC Edit validates that the occurrence codes on the Claim are valid.
Y16	The OSC Edit validates that the occurrence span codes on the Claim are valid.
Y17	The SOA Edit identifies Claims that contain an invalid Source of Admission code.	16	MA42
Y18	The TOA Edit identifies Claims that contain an invalid Type of Admission code.	16	MA41
Y19	Edit identifies line items that are potentially duplicates when two lines entered on one or more Claims are identical.	18	N522
Y20	Identifies an entire outpatient Claim that is a potential duplicate of a previously submitted outpatient Claim.
Y21	Edit identifies an entire inpatient Claim that is a potential duplicate of a previously submitted inpatient Claim.	18	N522
Y22	Identifies an entire inpatient Claim that is a potential duplicate of a previously submitted inpatient Claim.
Y23	Edit occurred because the first listed Diagnosis field is blank or any Diagnosis code is not valid for Service dates on the Claim.	146	M76
Y24	Edit occurred because the Diagnosis code includes an age range and the patient age is outside of that range.	9	N657
Y25	Edit occurred because the Diagnosis code includes gender designation and the patient gender does not match.	16	MA39
Y26	Edit occurred because the Diagnosis code has an MSP alert warning indicator.
Y27	Edit occurred because the first letter of the first listed Diagnosis code is an E.	146	M76
Y28	Edit occurred because the submitted Procedure code is not valid for the Service dates on the Claim.	181	M20
Y29	Edit occurred because the Procedure code includes an age range and the patient age is outside of that range.
Y30	Edit occurred because the Procedure code includes gender designation and the patient gender does not match.	16	MA39
Y31	Edit occurred because the Procedure code has a noncovered Service indicator meaning it is not covered.	96	N115
Y32	Edit occurred because Condition Code 21 indicates the provider is requesting verification of denial.	96	N30
Y33	Edit occurred because the Claim was submitted with Condition Code 20.	16	M44
Y34	Edit occurred because the Procedure code has a questionable covered Service indicator.	16	N657
Y35	Edit occurred because a Procedure code indicates a Service N/C by Medicare based on the type of bill and condition codes on Claim.
Y36	Edit occurred because the Procedure code does not have an OPPS indicator, but may be payable in other settings.
Y37	Edit occurred because the sum of units or all lines with the same proc except lab with mod 91, exceeds the max allowed for proc.
Y38	Edit occurred because multiple exclusive bilateral proc codes are present, 2 or more times on the same svc date, without a mod 50.
Y39	Edit occurred where multiple exclusive bilateral Procedure codes are present on same Service date with or without modifier 50.	4	N519
Y40	Edit occurred because Medicare designated Procedure as pay status C meaning Procedure is not covered when performed as outpatient.	5	M77
Y41	Edit occurred because two mutually exclusive Procedures were billed with same Service date.	234	M80
Y42	Procedure is one of a pair of mutually exclusive Procedures and both codes exist on a Claim with the same Service date.	234	M15
Y43	Edit occurred because the Procedure is identified as a component of another Procedure also on the Claim for the same Service date.	97	M15
Y44	Edit occurred because the Procedure is identified as a component of another Procedure also on the Claim for the same Service date.	97	M15
Y45	Edit occurred because one or more type T or S Procedures are on same day as an Evaluation Management code without modifier 25.	182	N657
Y46	Edit occurred because the modifier is not in the list of valid Outpatient Prospective Payment System modifiers.	182	N657
Y47	Only Edits for valid modifiers not specific to outpatient facility Claims.	182	N657
Y48	Edit occurred because the From, Thru, or Service date is invalid or Service dt falls outside range of the From and Thru dates.
Y49	Edit occurred because the age is non-numeric or outside the range of 0-124 years.	50	N129
Y50	Service is not covered for  member. The provider should submit the proper code or medical documentation.	16	MA39
Y51	Edit occurred because only incidental Services were reported.	97	N20
Y52	Edit occurred because Procedure code indicator is Not Recognized.	16	N657
Y53	Edit occurred because the principal Diagnosis is not related to mental health on a partial hospitalization Claim.	16	MA63
Y54	Edit occurred because Ambulatory Payment Class 323 or 324 or 325 is present and three or more qualifying criteria are not present.	16	N657
Y55	Edit occurred because electroconvulsive therapy or a significant Procedure occurs on the same day as partial hospitalization.
Y56	Edit occurred because a partial hospitalization Claim is suspended for medical review and does not span more than three days.	16	N657
Y57	Edit occurred because Claims suspended for medical review and spans more than three days and mental health Services not 57 percent.	16	N657
Y58	Edit occurred because Claims suspended for medical review and spans more than three days and mental health Services not 57 percent.	16	N657
Y59	Edit occurred because a mental health Service assigned to Ambulatory Payment Class 323 or 324 or 325 does not exist.	16	N657
Y60	Edit occurred because electroconvulsive therapy or a non-mental health proc is present on same day as extensive mental hlth svcs.
Y61	Modifier 73 is present with an independent or conditional bilateral Procedure with modifier 50 or a Procedure with more than 1 unit.	4	N519
Y62	Edit occurred because the Claim contains an implanted device with no surgical or other Service to implant the device.	16	M67
Y63	Edit occurred because one of a pair of mutually exclusive Procedures with same Service date and no qualifying NCCI modifier.	4	N519
Y64	Edit occurred because one of a pair of mutually exclusive Procedures with same Service date and no qualifying NCCI modifier.	4	N519
Y65	Procedure is a component of another code on the Claim without a qualifying NCCI modifier on the same day.	4	N519
Y66	Procedure is a component of another code on the Claim without a qualifying NCCI modifier on the same day in history.	4	N519
Y67	The Edit occurred because  is not a valid revenue code.	16	M50
Y68	Edit occurred because multiple medical visits are present on the same day with the same Revenue Code without Condition Code G0.	16	M44
Y69	HCPCS code 36430 requires a HCPCS code for the blood product to billed for the same date of Service.	16	M51
Y70	Edit occurred because Observation Revenue code 762 is used with a Procedure code that does not represent an Observation Service.	199	N657
Y71	Edit occurred because Services with Service indicator C are present on a separate Procedure list.	96	M2
Y72	Edit occurred because Type of Bill 12X or 14X is present with Condition Code 41.	16	MA30
Y73	Edit occurred because Claim consists entirely of a combination of lines that are denied or rejected or are considered packaged.	97	N390
Y74	Edit occurred because Claim line contains a revenue code that requires a Procedure code.	16	M20
Y75	Edit is assigned to all other Claim lines when one or more line contains a Procedure code with a status indicator of C.	96	M2
Y76	Edit occurred because a Claim line contains a Procedure code which is noncovered by statute.	96	N425
Y77	Edit occurred because multiple observations on Claim are paid separately if the required criteria are met for each one.
Y78	Edit occurred because Claim shows billable observation but dx is not in list of dx codes that qualify for separate observation py
Y79	Edit occurred because observation codes G0243 or G0244 are billed on a Claim with Type of Bill not equal to 13X.	16	MA30
Y80	Edit occurred because blood components that are not allowed to be coded together are reported on the same Date of Service.	96	N56
Y81	Edit occurred because Procedure code starting with letter C is used without Bill Type 12X or 13X or 14X.	16	MA30
Y82	Edit occurred because no E/M visit the day of or the day before the observation and the date of observation is not 12/31 or 1/1.
Y83	Edit occurred because no Evaluation Management visit the day of or day before the observation and date is December 31 or January 1.	96	N56
Y84	Edit occurred because code G0379 is present w/o code G0378 for same Claim with bill type 13x	96	N56
Y85	Edit occurred because code G0292 or G0293 or G0294 are on the Claim and Diagnosis V707 is not present as admit or second Diagnosis.	16	MA65
Y86	Edit occurred because modifier CA is on 1 or more lines with Indicator C and same Service date or modifier CA with multiple units.	96	N56
Y87	Edit occurred because proc code reported has a status indicator of Y indicating item can only be billed to DME Regional Carrier.	16	M51
Y88	Edit occurred because Procedure is not reportable on an Outpatient Prospective Payment System Claim.	96	N56
Y89	Edit occurred because Procedure G0129 Occupational Therapy is furnished as a component of partial hospitalization treatment program.	96	N56
Y90	Edit occurred because Procedure G0176 Activity Therapy furnished as a component of partial hospitalization treatment program daily.	96	N56
Y91	Edit occurred because the line item contains a revenue code that is not recognized.	16	M50
Y92	Edit occurred because C9399 was billed which is a drug that received Federal Drug Administration approval but is an unlisted code.	16	N350
Y93	Edit occurred because the Service was performed prior to the date of Federal Drug Administration approval.	188	N386
Y94	Edit occurred because the Service was performed prior to the effective date as specified in the National Coverage Determination.	96	N386
Y95	Edit occurred because the Service was performed outside an approved clinical trial period.	96	M61
Y96	Edit occurred because modifier CA has been reported and 20 is not patient status code in form locator 22.	182	N657
Y97	Edit occurred because a Procedure was not reported with 1 or more associated device codes.	96	N56
Y98	Edit occurred because a Procedure code has a status indicator of M and it cannot be reported to the fiscal intermediary.	16	M51
Y99	Edit occurred because blood products are billed with Revenue code 39X and modifier BL without a line billed with Revenue Code 38X.	16	M50
Z01	The Account ID is missing.	16	N382
Z02	The Procedure code was crosswalked to an appropriate anesthesia code.	59
Z03	Claim line is being disallowed because the anesthesia Procedure code was performed by a non-anesthesia provider.	96	N95
Z04	Claim line is not reimbursed because more than one anesthesia Procedure code was billed on the same date of Service.	59	N633
Z05	Service is not paid in addition to another anesthesia Service on the same day.	59	N633
Z06	Claim line is being disallowed because there is a missing or invalid beginning or ending date of Service (DOS).	16	MA31
Z07	line is eligible for a Bilateral Procedure Reduction.	59	N644
Z08	The place of Service code is missing or invalid.	16	M77
Z09	The surgical Procedure cannot be crosswalked to an anesthesia code without report.	252	M29
Z10	Service is not normally performed for members in  age range.	6	N129
Z11	It  is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.	181	M20
Z12	It is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.	181	M20
Z13	Service is not covered for  member. The provider should submit the proper code or medical documentation.	7	N115
Z14	Documentation is required when a modifier 59 is billed with the Procedure code.	252	M127
Z15	It is a duplicate of previous Claim. If corrected billing please resubmit according to billing guidelines.	18	N522
Z16	Claim line is being disallowed because the patients date of birth is missing, invalid, or after the date of Service.	16	N329
Z17	Claim line is being disallowed because number of units doesn’t match the date span between the beginning and ending dates of Service.	16	N345
Z18	It is a duplicate of a previous Claim. If corrected billing please resubmit according to billing guidelines.	18	N522
Z19	The System was unable to obtain results for  Claim line.
Z20	Claim line is being disallowed because an E and M code is within the global period with a same Diagnosis category by same provider.	97	N525
Z21	The Procedure code on  Claim line is retained from a transfer relationship.	97	M15
Z22	Claim line is disallowed because a surgical code was submitted w/in the period w/a Dx from same category by the same provider.	97	N525
Z23	A history Claim line is disallowed because its Procedure code is unbundled and is considered exclusive.	97	M80
Z24	A history Claim line is disallowed because its Procedure code is unbundled and is considered unbundled.	97	M80
Z25	A history Claim line is disallowed because its Procedure code is disallowed as part of a rebundle relationship.	97	M80
Z26	A Procedure code on a history Claim line was part of a transfer relationship, but the Procedure code was retained.
Z27	condition is not normal for  patient age.	9	N657
Z28	Service is not covered when performed for the reported Diagnosis.	50	M64
Z29	Service is not covered when performed for the reported Diagnosis.	50	M64
Z30	Claim line is being disallowed because there is no primary Diagnosis code.	16	MA63
Z31	The Procedure can be crosswalked to two or more anesthesia codes and review is required to determine the appropriate code.	252	M29
Z32	Claim line is being disallowed because Diagnosis code requires a fourth and/or fifth digit to provide appropriate specificity.	16	M64
Z33	The Claim line contains an inappropriate modifier combination.	4	N519
Z34	It is an invalid modifier for  date of Service. The provider should submit the proper code.	4	N519
Z35	condition is not normal for  patient gender.	16	N657
Z36	Procedure requires modifier 26 be billed.	4	N517
Z37	Reimbursement for surgical assistant is not allowed on  Procedure code.	54	N646
Z38	Edit occurred because the Bilateral adjustment does not apply to  Procedure code.
Z39	It is a bundled Service. The payment is included in the Service to which item or Service is incident.	234	M15
Z40	It is a bundled Service. The payment is included in the Service to which item or Service is incident.	234	M15
Z41	The provider who rendered these Services is not eligible to assist during surgery.	96	N95
Z42	Edit occurred because the Procedure requires supporting documentation for an assistant surgeon.	252	M29
Z43	Edit occurred because the Procedure requires supporting documentation for a co-surgeon.	252	M29
Z44	Edit occurred because the Procedure requires supporting documentation for team surgery.	252	M29
Z45	Procedure is redundant to the primary Procedure and is limited by  member plan.	234	M15
Z46	Service is a part of the original surgical Procedure and is limited by  member plan.	234	M15
Z47	modifier is not compatible with  Procedure code. The provider should submit the proper code.	4	N519
Z48	is a bundled Service. The payment is included in the Service to which item or Service is incident.	234	M15
Z49	code or modifier or provider type is invalid.	4	N517
Z50	Edit occurred because a non-covered Service was submitted. The member is not liable for these Charges.	96	N30
Z51	It is a deleted or invalid code or modifier for  date of Service The provider should submit the proper code.	4	N519
Z52	modifier is not compatible with  Procedure code. The provider should submit the proper code.	4	N517
Z53	line is eligible for a multiple Procedure reduction.	59
Z54	Physical therapy is not covered in  place of Service. The member is not liable for these Charges.	96	N428
Z55	Service is a part of the original surgical Procedure and is limited by  member plan.	97	M15
Z56	It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.	182	N657
Z57	A Claim line in history is disallowed because its Procedure code is unbundled to a line on  Claim.	234	M15
Z58	Procedure is considered part of the primary Procedure and is limited by  member plan.	234	M15
Z60	Service is not covered when performed for the reported Diagnosis.	16	M64
Z61	Procedure should not be billed since the member is an established patient.	B16
Z62	Claim line is being disallowed because the patient ID is missing or invalid.	16	N382
Z63	is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.	4	N519
Z64	The place of Service is not typical for the Procedure code.	5	M77
Z65	line is eligible for a Assistant/Co/Team Surgery modifier reduction.
Z66	Procedure is considered part of the primary Procedure and is limited by  member plan.	97	M15
Z67	Service is a part of the original surgical Procedure and is limited by  Member’s plan.	97	M144
Z68	Claim line is being disallowed because the provider ID is missing or invalid.	207	N257
Z69	The patient gender is missing or invalid.	16	MA39
Z70	Claim line is being disallowed because the Procedure code is disallowed as part of a rebundle relationship.	97	M80
Z71	Procedure does not normally require the Services of an assistant surgeon.	54	N646
Z72	Claim line is being disallowed because the Procedure code does not typically allow an assistant surgeon modifier.	54	N646
Z74	Edit occurred because a Diagnosis code on the line is a possible third party liability.	20
Z75	A transfer to an appropriate Procedure occurred.  Claim lines Procedure was part of the transfer group.	97	M15
Z76	Claim line is being disallowed because the Procedure code is unbundled and is considered exclusive.	97	M80
Z77	Claim line is being disallowed because the Procedure code is unbundled and is considered unbundle.	97	M80
Z78	Edit occurred because the Procedure code is unlisted.	16	M51
Z79	Procedure is considered cosmetic and is not a covered Service under  Member’s plan.	96	N383
Z80	Procedure is considered investigative and is not a covered Service under  Member’s plan.	55	N623
Z81	Unbundled Proc – Incidental
Z82	Unbundled Hx Proc – Incidental.
Z83	Bilateral Procedure Reduction	59	N644
Z84	Multiple Procedure Reduction	59
Z85	CA modifier requires patient status code 20.
Z86	Missing or Invalid Additional Procedure.
Z87	Missing or Invalid Diagnosis for Code to Code.
Z88	Service is not covered when performed for the reported Diagnosis.	16	M64
Z89	modifier is not compatible with  Procedure code. The provider should submit the proper code.	96	N115
Z90	Service is not covered when performed for the reported Diagnosis.	50	M64
Z91	Edit occurred because a primary Diagnosis code is missing or invalid due to a Local or National Coverage Determination.	16	MA63
Z92	Edit occurred because a secondary Diagnosis code is missing or in valid due to a Local or National Coverage Determination.	16	M76
Z93	Service is not covered when performed for the reported Diagnosis.	16	M64
Z95	The frequency and/or Diagnosis does not meet policy requirements for Procedure due to a Local or National Coverage Determination.	11	N386
Z96	LCD Part B Frequency with Diagnosis Override.
Z97	The place of Service does not meet policy requirements for Procedure code due to a Local or National Coverage Determination.	16	M77
Z98	The patient’s gender does not meet policy requirements due to a Local or National Coverage Determination.	16	MA39
Z99	The age does not meet policy requirements for Procedure or Diagnosis due to a Local or National Coverage Determination.	50	N129

The following explanation codes or Blue Cross Blue Shield denial codes for remittance and descriptions are based on those that appear in paper (paper) Commercial remittance advice. The identical codes and descriptions are also applicable to commercial remittance advice online that is available on BlueAccess the secure portion on www.bcbst.com. Although the information/action column of the provider isn’t in the remittance guidance however, we have added the information on this page to aid you.

Electronic remittance guidance that is HIPAA compliant (ANSI-835) does not employ the explanation code. Electronic remittance guidance (ANSI-835) utilizes HIPAA-compliant remark as well as adjustment reasons codes. 

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